子宮頸癌術(shù)后輔助性放療不同照射技術(shù)臨床比較研究
發(fā)布時(shí)間：2018-10-18 09:01
【摘要】：目的子宮頸癌術(shù)后病理存在高危因素的患者,術(shù)后輔助放療可提高療效,改善預(yù)后。常用的放療技術(shù)有調(diào)強(qiáng)放射治療(intensity modulated radiotherapy,IMRT)、三維適形放療(three-dimensional conformal radiotherapy,3D-CRT)和常規(guī)放療(conventional radiotherapy,CRT),本研究旨在比較這3種放療技術(shù)的劑量學(xué)、毒副作用、療效及生存情況的差異,從而找出一種更佳的放療方案。方法選取2009-01-10-2015-07-10臨沂市腫瘤醫(yī)院接受放療的341例宮頸癌術(shù)后存在高危因素患者,分為IMRT組患者128例、3D-CRT組患者77例和CRT組患者136例。IMRT組PTV 50.4~54Gy,3D-CRT組PTV45~50.4Gy,CRT組處方劑量DT41.4~45Gy。體外放療同時(shí)給予化療。隨機(jī)選取10例患者重新制定IMRT計(jì)劃、3D-CRT計(jì)劃和CRT計(jì)劃。采用SPSS 22.0統(tǒng)計(jì)軟進(jìn)行數(shù)據(jù)分析,比較危及器官(organ at risk,OAR)受照射劑量、靶區(qū)劑量、急慢性毒副作用、療效及生存情況。結(jié)果 IMRT計(jì)劃、3D-CRT計(jì)劃和CRT計(jì)劃的OAR受照射劑量差異有統(tǒng)計(jì)學(xué)意義(脊髓F=1 070.038,P0.001;股骨頭F=103.277,P0.001;小腸F=208.677,V=13.776,P0.001;膀胱F=303.481,V=13.330,P0.001;直腸F=230.452,V=13.272,P0.001。3組患者的靶區(qū)劑量差異有統(tǒng)計(jì)學(xué)意義,χ~2=293.059,P0.001。IMRT組與3D-CRT組比較,Z=-11.096,P0.001;IMRT組與CRT組比較,Z=-14.281,P0.001;3D-CRT組與CRT組比較,Z=-12.401,P0.001,差異均有統(tǒng)計(jì)學(xué)意義。3組的急性消化道反應(yīng)(χ~2=11.848,P=0.003)、泌尿系統(tǒng)反應(yīng)(χ~2=10.390,P=0.006)、骨髓抑制(χ~2=14.154,P=0.001)、慢性消化道反應(yīng)(χ~2=19.242,P0.001)、泌尿系統(tǒng)反應(yīng)(χ~2=15.670,P0.001)差異均有統(tǒng)計(jì)學(xué)意義。3組靶區(qū)內(nèi)外轉(zhuǎn)移率比較顯示,IMRT組靶區(qū)內(nèi)復(fù)發(fā)率有降低趨勢,但無統(tǒng)計(jì)學(xué)意義(χ~2=5.327,P=0.070),靶區(qū)外轉(zhuǎn)移率差異無統(tǒng)計(jì)學(xué)意義,χ~2=1.370,P=0.504。3組無瘤生存期(disease-free survival,DFS)差異無統(tǒng)計(jì)學(xué)意義(P=0.054),其中IMRT組較CRT組明顯提高(P=0.013),IMRT組較3D-CRT組差異無統(tǒng)計(jì)學(xué)意義(P=0.123),3D-CRT組較CRT組差異無統(tǒng)計(jì)學(xué)意義(P=0.532)。3組總生存期(overall survival,OS)差異有統(tǒng)計(jì)學(xué)意義(P=0.024),其中IMRT組OS較CRT組明顯提高(P=0.008),IMRT組較3D-CRT組差異無統(tǒng)計(jì)學(xué)意義(P=0.259),3D-CRT組較CRT組差異無統(tǒng)計(jì)學(xué)意義,P=0.213。將宮旁受侵、淋巴轉(zhuǎn)移、深肌層受侵、脈管癌栓、靶區(qū)內(nèi)外轉(zhuǎn)移進(jìn)行多因素分析,深肌層受侵是患者獨(dú)立預(yù)后不良因素,P=0.047,HR=2.362,95%CI為1.013~5.508。結(jié)論對宮頸癌術(shù)后具有不良預(yù)后因素患者,IMRT可獲得理想的劑量分布,IMRT技術(shù)與其他技術(shù)相比具有明顯劑量學(xué)優(yōu)勢,OAR受照射劑量降低,靶區(qū)劑量明顯提高,毒副作用減少,靶區(qū)內(nèi)復(fù)發(fā)率有降低趨勢,總生存率提高。
[Abstract]:Objective: postoperative adjuvant radiotherapy can improve the curative effect and prognosis of patients with cervical cancer with high risk factors. The commonly used radiotherapy techniques include intensity modulated radiotherapy (intensity modulated radiotherapy,IMRT), three-dimensional conformal radiotherapy (three-dimensional conformal radiotherapy,3D-CRT) and conventional radiotherapy (conventional radiotherapy,CRT). The purpose of this study was to compare the dosimetry, side effects, efficacy and survival of these three radiotherapy techniques. In order to find a better radiotherapy program. Methods 341 patients who received radiotherapy in Linyi Cancer Hospital from 2009-01-10 to 2015-10 were divided into IMRT group (128 cases), 3D-CRT group (77 cases) and CRT group (136 cases). The prescription dose of DT41.4~45Gy. in PTV 50.4 Gy 3D-CRT group, PTV45~50.4Gy,CRT group, IMRT group was 50.4 GY3D-CRT. External radiotherapy was given at the same time as chemotherapy. Ten patients were randomly selected to reformulate IMRT plan, 3D-CRT plan and CRT plan. SPSS 22.0 statistical software was used to analyze the data, to compare the radiation dose, target dose, acute and chronic toxicity, curative effect and survival status of (organ at risk,OAR. Results there were statistically significant differences in the dose of OAR exposure between IMRT, 3D-CRT and CRT (spinal cord 10 070.038 渭 P 0.001; femoral head 103.277U P 0.001; small intestine F208.677V 13.776U P 0.001; bladder F303.481V13.330P0.001; F230.452V 13.272 P 0.001.3; 蠂 ~ 2293.059P 0.001.Compared with 3D-CRT group, Z-11.096m P 0.001IMRT was significantly different from that of 3D-CRT group.) there was significant difference in the dose of the target area between the two groups (蠂 ~ 2293.0599P 0.001.ImRT group), compared with the 3D-CRT group (P 0.001). The dose difference was statistically significant in the patients with F303.481V13.330P0.001.The dose difference between the two groups was statistically significant (蠂 ~ 2293.0599P 0.001.Compared with that of the 3D-CRT group). Compared with CRT group, there were significant differences in acute digestive tract reaction (蠂 ~ 2), urinary system reaction (蠂 ~ 210.390P ~ 0.006), bone marrow suppression (蠂 ~ 2n 14.154 P ~ 0.001), chronic digestive tract reaction (蠂 ~ 2n 19.242P ~ 0.001) and urinary system reaction (蠂 ~ 215.670 P ~ 0.001) between Z-14.281P 0.001D CRT group and CRT group (P 0.001), and there were significant differences between the three groups in acute digestive tract reaction (蠂 ~ 215.670p ~ 0.003), chronic digestive tract reaction (蠂 ~ 2n 19.242P0.001) and urinary system response (蠂 ~ 215.670p ~ 0.001) in the three groups (蠂 ~ 210.390P 0.006), chronic digestive tract reaction (蠂 ~ 2n 19.242P0.001), urinary system response (蠂 ~ 215.670p 0.001). The recurrence rate of target area in IMRT group was lower than that in other three groups. However, there was no statistical significance (蠂 ~ 2 ~ 2 ~ (5.327) P ~ (0. 070), there was no significant difference in the rate of metastasis outside the target area, and there was no significant difference in tumor-free survival (disease-free survival,DFS) in 蠂 ~ 2 ~ (1.370) P ~ (0.504.3) group (P0. 054). Among them, IMRT group was significantly higher than CRT group (P 0. 013), IMRT group vs 3D-CRT group) (P0. 123), and 3D-CRT group was worse than CRT group (P < 0. 123). The total survival time (overall survival,OS) of the three groups was significantly higher than that of the CRT group (P0. 024). The OS of the IMRT group was significantly higher than that of the CRT group (P0. 008), IMRT group compared with the 3D-CRT group (P0. 259), and the 3D-CRT group had no statistical significance compared with the CRT group (P0. 213). Multivariate analysis was carried out on periuterine invasion, lymphatic metastasis, deep myometrial invasion, vascular tumor embolus, external and internal metastasis of target area. The invasion of deep muscular layer was an independent prognostic factor. The CI of 2.36295 CI was 1.0131355.508. Conclusion IMRT can obtain ideal dose distribution in patients with adverse prognostic factors after cervical cancer surgery. Compared with other techniques, IMRT technique has obvious dosimetric advantages. The dose of OAR is decreased, the dose of target area is increased, and the side effects of OAR are decreased. The recurrence rate in target area decreased and the overall survival rate increased.
【作者單位】： 臨沂市腫瘤醫(yī)院婦一科;山東大學(xué)附屬山東省腫瘤醫(yī)院婦瘤科;山東大學(xué)附屬山東省腫瘤醫(yī)院放療科;
【基金】：山東省醫(yī)藥衛(wèi)生科技發(fā)展計(jì)劃(2016WS0246)
【分類號(hào)】：R737.33
，
本文編號(hào)：2278642
[Abstract]:Objective: postoperative adjuvant radiotherapy can improve the curative effect and prognosis of patients with cervical cancer with high risk factors. The commonly used radiotherapy techniques include intensity modulated radiotherapy (intensity modulated radiotherapy,IMRT), three-dimensional conformal radiotherapy (three-dimensional conformal radiotherapy,3D-CRT) and conventional radiotherapy (conventional radiotherapy,CRT). The purpose of this study was to compare the dosimetry, side effects, efficacy and survival of these three radiotherapy techniques. In order to find a better radiotherapy program. Methods 341 patients who received radiotherapy in Linyi Cancer Hospital from 2009-01-10 to 2015-10 were divided into IMRT group (128 cases), 3D-CRT group (77 cases) and CRT group (136 cases). The prescription dose of DT41.4~45Gy. in PTV 50.4 Gy 3D-CRT group, PTV45~50.4Gy,CRT group, IMRT group was 50.4 GY3D-CRT. External radiotherapy was given at the same time as chemotherapy. Ten patients were randomly selected to reformulate IMRT plan, 3D-CRT plan and CRT plan. SPSS 22.0 statistical software was used to analyze the data, to compare the radiation dose, target dose, acute and chronic toxicity, curative effect and survival status of (organ at risk,OAR. Results there were statistically significant differences in the dose of OAR exposure between IMRT, 3D-CRT and CRT (spinal cord 10 070.038 渭 P 0.001; femoral head 103.277U P 0.001; small intestine F208.677V 13.776U P 0.001; bladder F303.481V13.330P0.001; F230.452V 13.272 P 0.001.3; 蠂 ~ 2293.059P 0.001.Compared with 3D-CRT group, Z-11.096m P 0.001IMRT was significantly different from that of 3D-CRT group.) there was significant difference in the dose of the target area between the two groups (蠂 ~ 2293.0599P 0.001.ImRT group), compared with the 3D-CRT group (P 0.001). The dose difference was statistically significant in the patients with F303.481V13.330P0.001.The dose difference between the two groups was statistically significant (蠂 ~ 2293.0599P 0.001.Compared with that of the 3D-CRT group). Compared with CRT group, there were significant differences in acute digestive tract reaction (蠂 ~ 2), urinary system reaction (蠂 ~ 210.390P ~ 0.006), bone marrow suppression (蠂 ~ 2n 14.154 P ~ 0.001), chronic digestive tract reaction (蠂 ~ 2n 19.242P ~ 0.001) and urinary system reaction (蠂 ~ 215.670 P ~ 0.001) between Z-14.281P 0.001D CRT group and CRT group (P 0.001), and there were significant differences between the three groups in acute digestive tract reaction (蠂 ~ 215.670p ~ 0.003), chronic digestive tract reaction (蠂 ~ 2n 19.242P0.001) and urinary system response (蠂 ~ 215.670p ~ 0.001) in the three groups (蠂 ~ 210.390P 0.006), chronic digestive tract reaction (蠂 ~ 2n 19.242P0.001), urinary system response (蠂 ~ 215.670p 0.001). The recurrence rate of target area in IMRT group was lower than that in other three groups. However, there was no statistical significance (蠂 ~ 2 ~ 2 ~ (5.327) P ~ (0. 070), there was no significant difference in the rate of metastasis outside the target area, and there was no significant difference in tumor-free survival (disease-free survival,DFS) in 蠂 ~ 2 ~ (1.370) P ~ (0.504.3) group (P0. 054). Among them, IMRT group was significantly higher than CRT group (P 0. 013), IMRT group vs 3D-CRT group) (P0. 123), and 3D-CRT group was worse than CRT group (P < 0. 123). The total survival time (overall survival,OS) of the three groups was significantly higher than that of the CRT group (P0. 024). The OS of the IMRT group was significantly higher than that of the CRT group (P0. 008), IMRT group compared with the 3D-CRT group (P0. 259), and the 3D-CRT group had no statistical significance compared with the CRT group (P0. 213). Multivariate analysis was carried out on periuterine invasion, lymphatic metastasis, deep myometrial invasion, vascular tumor embolus, external and internal metastasis of target area. The invasion of deep muscular layer was an independent prognostic factor. The CI of 2.36295 CI was 1.0131355.508. Conclusion IMRT can obtain ideal dose distribution in patients with adverse prognostic factors after cervical cancer surgery. Compared with other techniques, IMRT technique has obvious dosimetric advantages. The dose of OAR is decreased, the dose of target area is increased, and the side effects of OAR are decreased. The recurrence rate in target area decreased and the overall survival rate increased.
【作者單位】： 臨沂市腫瘤醫(yī)院婦一科;山東大學(xué)附屬山東省腫瘤醫(yī)院婦瘤科;山東大學(xué)附屬山東省腫瘤醫(yī)院放療科;
【基金】：山東省醫(yī)藥衛(wèi)生科技發(fā)展計(jì)劃(2016WS0246)
【分類號(hào)】：R737.33
，
本文編號(hào)：2278642
本文鏈接：http://sikaile.net/yixuelunwen/zlx/2278642.html
最近更新
教材專著
