论文部分内容阅读
目的:探讨调强适形放射疗法（IMRT）和三维适形放射疗法（3DCRT）治疗ⅡB~ⅢB期宫颈癌时膀胱、直肠、小肠受照剂量。方法:回顾性分析浙江省肿瘤医院2018年1—12月25例ⅡB~ⅢB期宫颈癌患者的临床资料。其中，采用3DCRT治疗12例（3DCRT组），采用IMRT治疗13例（IMRT组）。采用正常组织接受20、40和60 Gy照射体积占总体积百分比（Vn 20、Vn 40和Vn 60）评估膀胱、直肠、小肠受照体积。比较两组放射性并发症和疗效。n 结果:IMRT组随着处方剂量的增加，膀胱和小肠Vn 20、Vn 40和Vn 60不断增大，差异有统计学意义（n P<0.01或0.05）；Vn 40和Vn 60随着处方剂量的增加不断增大，差异有统计学意义（n P<0.01或<0.05）；在同一处方剂量下，IMRT组膀胱Vn 20、Vn 40和Vn 60及小肠Vn 40和Vn 60均明显小于3DCRT组，差异有统计学意义（n P0.05）；Vn 40和Vn 60随着处方剂量的增加不断增大，差异有统计学意义（n P<0.01或<0.05）；在同一处方剂量下，IMRT组Vn 40和Vn 60均明显小于3DCRT组，差异有统计学意义（n P<0.05）。IMRT组放射性肠炎、放射性膀胱炎和骨髓抑制发生率及总并发症发生率均明显低于3DCRT组（1/13比3/12、0比3/12、1/13比4/12和2/13比10/12），差异有统计学意义（n P0.05）。n 结论:与3DCRT比较，IMRT治疗ⅡB~ⅢB期宫颈癌对周围器官的放射性损伤较小，且放射性并发症发生率低，安全性更好。“,”Objective:To investigate the dose of intensity-modulated conformal radiotherapy (IMRT) and three dimensional conformal radiotherapy (3DCRT) for bladder, rectum and small intestine in stage ⅡB to ⅢB cervical cancer.Methods:The clinical data of 25 patients with stage ⅡB to ⅢB cervical cancer in Zhejiang Cancer Hospital from January to December 2018 were retrospectively analyzed. Among them, 12 patients were treated with 3DCRT (3DCRT group) and 13 patients were treated with IMRT (IMRT group). The volume of the bladder, rectum, and small intestine was evaluated using normal tissues receiving 20, 40, and 60 Gy irradiation volume percentages (Vn 20, Vn 40 and Vn 60). The radiological complications and curative effect were compared between 2 groups.n Results:In IMRT group, with the increase of the prescribed dose, the bladder Vn 20, Vn 40 and Vn 60 continued to increase, and there was statistical difference (n P0.05), the bladder Vn 40 and Vn 60 continued to increase, and there was statistical difference (n P<0.01 or <0.05); at the same prescribed dose, the bladder Vn 20, Vn 40 and Vn 60 and the small intestine Vn 40 and Vn 60 in IMRT group were significantly smaller than those in 3DCRT group, and there were statistical differences (n P0.05); the Vn 40 and Vn 60 increased with the increase of the prescribed dose, and there were statistical differences (n P<0.01 or <0.05); at the same prescription, Vn 40 and Vn 60 in IMRT group were significantly smaller than those in 3DCRT group, and there were statistical differences (n P<0.05). The incidences of radiation enteritis, radiation cystitis, bone marrow suppression and the incidence of total complications in IMRT group were significantly lower than those in 3DCRT group (1/13 vs. 3/12, 0 vs. 3/12, 1/13 vs. 4/12 and 2/13 vs. 10/12), and there were statistical differences (n P0.05).n Conclusions:Compared with 3DCRT, IMRT treatment of stage ⅡB to ⅢB cervical cancer has less radiation damage to peripheral organs, and has a lower incidence of radiation complications and better safety.