Mundt A J, Roeske J C, Lujan A E, Yamada S D, Waggoner S E, Fleming G, Rotmensch J
Department of Radiation and Cellular Oncology, University of Chicago Hospitals, Chicago, Illinois 60637, USA.
Gynecol Oncol. 2001 Sep;82(3):456-63. doi: 10.1006/gyno.2001.6250.
Our goal in this article to describe our initial experience with intensity-modulated whole-pelvis radiation therapy (IM-WPRT) in gynecologic malignancies.
Between February and August 2000, 15 women with cervical (9) or endometrial (6) cancer received IM-WPRT. All patients received a treatment planning computed tomography (CT) scan. On each scan, the target volume (upper vagina, parametrial tissues, presacral region, uterus, and regional lymph nodes) and normal tissues (small bowel, bladder, and rectum) were identified. Using commercially available software, an IM-WPRT plan was generated for each patient. The goal was to provide coverage of the target with the prescription dose (45 Gy) while minimizing the volume of small bowel, bladder, and rectum irradiated. Acute gastrointestinal (GI) and genitourinary (GU) toxic effects in these women were compared with those seen in 25 patients treated with conventional WPRT.
IM-WPRT plans provided excellent coverage of the target structures in all patients and were highly conformal, providing considerable sparing of the bladder, rectum, and small bowel. Treatment was well tolerated, with grade 0-1 GI and GU toxicity in 46 and 93% of patients, respectively. IM-WPRT patients had a lower rate of grade 2 GI toxicity (53.4% vs 96%, P = 0.001) than those treated with conventional WPRT. Moreover, the percentage of women requiring no or only infrequent antidiarrheal medications was lower in the IM-WPRT group (73.3% vs 20%, P = 0.001). While grade 2 GU toxicity was also lower in the IM-WPRT patients (6.7% vs 16%), this difference did not reach statistical significance (P = 0.38).
IM-WPRT provides excellent coverage of the target structures while sparing critical neighboring structures in gynecology patients. Treatment is well tolerated with less acute GI toxicity than conventional WPRT. More patients and longer follow-up are needed to evaluate the full merits of this approach.
本文旨在描述我们在妇科恶性肿瘤调强全盆腔放射治疗（IM-WPRT）方面的初步经验。
2000年2月至8月期间，15例宫颈癌（9例）或子宫内膜癌（6例）患者接受了IM-WPRT治疗。所有患者均接受了治疗计划计算机断层扫描（CT）。在每次扫描中，确定靶区（上阴道、宫旁组织、骶前区域、子宫和区域淋巴结）和正常组织（小肠、膀胱和直肠）。使用商用软件为每位患者生成IM-WPRT计划。目标是在给予处方剂量（45 Gy）的同时覆盖靶区，同时尽量减少受照射的小肠、膀胱和直肠体积。将这些患者的急性胃肠道（GI）和泌尿生殖系统（GU）毒性反应与25例接受传统全盆腔放射治疗（WPRT）的患者进行比较。
IM-WPRT计划在所有患者中均能很好地覆盖靶区结构，且高度适形，对膀胱、直肠和小肠有明显的保护作用。治疗耐受性良好，分别有46%和93%的患者出现0-1级GI和GU毒性反应。IM-WPRT患者2级GI毒性发生率低于传统WPRT患者（53.4%对96%，P = 0.001）。此外，IM-WPRT组中不需要或仅偶尔需要止泻药物的女性比例较低（73.3%对20%，P = 0.001）。虽然IM-WPRT患者2级GU毒性也较低（6.7%对16%），但这种差异未达到统计学意义（P = 0.38）。
IM-WPRT能很好地覆盖靶区结构，同时保护妇科患者邻近的关键结构。与传统WPRT相比，该治疗耐受性良好，急性GI毒性较小。需要更多患者和更长时间的随访来评估这种方法的全部优点。
