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目的:探讨调强放射治疗(intensity modulated radiotherapy,IMRT)应用于宫颈癌治疗后主动脉旁淋巴结转移的剂量学特点、治疗效果及在减少并发症方面的价值。方法:选取2005-06-01-2012-12-30临沂市肿瘤医院(65例)和山东省肿瘤医院(51例)接受全程IMRT或适形放疗(conventional radiotherapy,CRT)治疗的116例主动脉旁淋巴结转移的宫颈癌患者。56例宫颈癌治疗后主动脉旁淋巴结转移患者接受全程IMRT,给予PTV剂量(58~69)Gy/(29~30)次,2.0~2.3Gy/次,中位剂量63.5Gy,随机选择10例患者,用三维治疗计划系统进行IMRT和常规放疗(CRT)计划设计,拟给予相同的处方剂量,比较危及器官受照射剂量。随机选择同期接受CRT(60例)患者,比较IMRT和CRT的靶区剂量、疗效、急性和晚期毒副作用及生存率。结果:56例患者均完成全程IMRT,95%的等剂量曲线可以覆盖99%的PTV体积,IMRT与拟行CRT计划比较,IMRT计划中小肠(t=2.958,P=0.016)、肾脏(t=14.438,P<0.001)和脊髓(t=34.511,P<0.001)受照射剂量明显降低,靶区剂量明显提高,t=20.924,P<0.001,IMRT组的急性和慢性毒副作用均明显减少,P<0.05。两组完全缓解率(χ2=11.048,P=0.001)、部分缓解率(χ2=5.893,P=0.015)和总有效率(χ2=32.251,P<0.001)比较差异均有统计学意义;1、3和5年生存率比较差异有统计学意义,χ2=9.530,P=0.002。结论:IMRT对宫颈癌治疗后主动脉旁淋巴结转移患者可获得理想的剂量分布,邻近危及器官得到保护,临床疗效满意,毒副作用明显减少,有效率提高,生存期明显延长。
Objective: To investigate the dosimetric characteristics, therapeutic effects and the value of decreasing the complications of intensity modulated radiotherapy (IMRT) applied to the aortic lymph node metastasis after cervical cancer treatment. Methods: A total of 116 aorta patients who underwent IMRT or conventional radiotherapy (CRT) in Linyi Cancer Hospital (65 cases) and Shandong Cancer Hospital (51 cases) from 2005-06-01 to 2012-12-30 Paralytic lymph node metastasis of cervical cancer patients. 56 patients with aortic lymph node metastasis after cervical cancer received full IMRT, PTV dose (58 ~ 69) Gy / (29 ~ 30) times, 2.0 ~ 2.3Gy / time, the median dose of 63.5Gy, a random selection of 10 cases Patients, with three-dimensional treatment planning system for IMRT and conventional radiotherapy (CRT) program design, intended to be given the same prescription dose, more endanger the organ irradiated dose. Patients receiving CRT (60 patients) at the same period were selected randomly to compare target dose, efficacy, acute and late side effects and survival rate of IMRT and CRT. Results: The complete IMRT was completed in 56 patients. The 95% isodose curve covered 99% of the volume of PTV. The IMRT was compared with the planned CRT. The IMRT planned small intestine (t = 2.958, P = 0.016) 14.438, P <0.001) and spinal cord (t = 34.511, P <0.001). The dose of target area was significantly increased at t = 20.924, P <0.001. The acute and chronic side effects of IMRT group were significantly reduced, P <0.05. The complete remission rate (χ2 = 11.048, P = 0.001), partial remission rate (χ2 = 5.893, P = 0.015) and total effective rate (χ2 = 32.251, The 3-year and 5-year survival rates were significantly different, χ2 = 9.530, P = 0.002. CONCLUSION: IMRT can achieve ideal dose distribution in patients with aortic lymph node metastasis after cervical cancer treatment. The adjacent organs endangered are protected. The clinical curative effect is satisfactory, the side effects are obviously reduced, the efficiency is improved and the survival time is obviously prolonged.