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自适应调强与单程调强放射治疗局部晚期宫颈癌的临床疗效及毒副反应对比分析
戚瑞虹,桂定清,张力忆
0
(达州市中心医院妇产科)
摘要:
【摘要】 目的 对比分析自适应调强放疗(ART)与单程调强放疗治疗局部晚期宫颈癌的临床疗效及毒副反应。方法 选取2011年1月~2012年1月于我院收治的108例局部晚期宫颈癌患者作为研究对象,回顾性分析所有患者的临床及随访资料,根据治疗方法将其分为对照组(n=50例)和观察组(n=58例)。对照组予以单程调强放疗治疗,观察组在常规临床治疗基础上予以ART,治疗期间2组均采用IMRT或IGRT技术进行外照射,且均同步实施以顺铂药物为基药的化疗方案,治疗结束后比较两组肿瘤体积和危及器官剂量学变化特点及两组近期临床疗效和远期生存情况,并记录2组患者其毒副反应的发生情况。结果 观察组经外照射15次后其GTV体积、pCTV体积和小肠体积较治疗前均明显缩小(P<005)。二程计划时其膀胱Dmean、Dmax、D01cc、Dlcc,直肠Dmean、Dmax、D 01cc、Dlcc,小肠Dmean、Dmax、V30、V45和V50水平均较首程计划降低,且除小肠外其余与首程计划时比较差异具有统计学意义(P<005)。两组各危及器官 DVH参数以及临床总有效率比较差异无统计学意义(P>005)。两组其随访5年后的OS和PFS比较差异均无统计学意义(P>005)。观察组急性腹泻发生率较对照组明显较低(P<005)。两组在血尿、尿频、肾盂积水、尿失禁、放射性膀胱炎、放射性结直肠炎、腹泻、大便失禁及结直肠出血等慢性毒副反应发生率比较差异无统计学意义(P>005)。结论 ART和单程调强放疗在治疗局部晚期宫颈癌患者上均具有显著的临床疗效,但ART治疗方案可明显减轻患者急性腹泻毒副反应的发生情况,具有更好的安全性,可在临床上推广使用。
关键词:  自适应调强放疗  单程调强放疗  局部晚期  宫颈癌  临床价值
DOI:
基金项目:四川省卫生和计划生育委员会科研课题(150055)
Clinical efficacy and side effects of adaptive intensity modulated radiotherapy and one way intensity modulated radiotherapy in the treatment of locally advanced cervical cancer
QI Ruihong,GUI Dingqing,ZHANG Liyi
(Department of Gynecology and Obstetrics, Dazhou Central Hospital)
Abstract:
【Abstract】 Objective The clinical efficacy and side effects of adaptive intensity modulated radiotherapy (ART) and oneway intensity modulated radiotherapy for the treatment of locally advanced cervical cancer were analyzed.Methods From January 2011 to January 2012, 108 patients with locally advanced cervical cancer were selected as the study subjects. The clinical and followup data of all patients were analyzed by retrospective analysis. According to the results of treatment in the data, they were divided into control group and observation group, 50 cases in each group. The control group was given oneway intensity modulated radiotherapy and the patients in the observation group were treated with ART on the basis of routine clinical treatment. Both groups of patients were treated with IMRT or IGRT for external beam irradiation during the treatment period, and cisplatinbased chemotherapy was simultaneously administered. After treatment, the tumor volume was compared between different patients, endangering the characteristics of organ dosimetry. The clinical curative effect and longterm survival of the control group and observation group were compared. The occurrence of side effects was recorded. Results The volume of GTV, the volume of pCTV and the volume of small intestine in observation group were significantly reduced after 15 times of external exposure (P<005). The urinary bladder Dmean, Dmax, D 01cc, Dlcc, rectal Dmean, Dmax, D 01cc, Dlcc, small intestine Dmean, Dmax, V30, V45 and V50 were all lower than the first. The difference between the rest of the small intestine and the first goal was statistically significant (P<005). There was no significant difference between the control group and the observation group in the parameters of OARs DVH and the total clinical efficiency (9200% vs 9655%) (P> 005). There was no significant difference between the control group and the observation group in the OS and PFS after 5 years of followup (8800% vs 9138% and 8000% vs 8793%, respectively) (P> 005). The incidence of acute diarrhea in the observation group was significantly lower than that in the control group, with statistically significant differences (P<005). There was no difference between the two groups in the incidence of chronic toxic and side effects such as hematuria, pollakiuria, hydronephrosis, urinary incontinence, radiation cystitis, radiation proctitis, diarrhea, fecal incontinence and colorectal hemorrhage. 005),the difference was not statistically significant (P> 005).Conclusion ART and oneway intensity modulated radiotherapy in the treatment of locally advanced cervical cancer patients have significant clinical efficacy, but ART treatment can significantly reduce the incidence of acute diarrhea in patients with adverse reactions, with better safety.
Key words:  Adaptive intensity modulated radiotherapy  One way intensity modulated radiotherapy  Locally advanced  Cervical cancer  Clinical value

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