Department of Gynecologic Oncology, Cancer Hospital of Harbin Medical University, 150 Haping Street, Nangang District, Harbin, Heilongjiang Province, PR China.
Radiat Oncol. 2012 Nov 23;7:197. doi: 10.1186/1748-717X-7-197.
To quantitatively evaluate the safety and related-toxicities of intensity modulated radiotherapy (IMRT) dose-volume histograms (DVHs), as compared to the conventional three-dimensional conformal radiotherapy (3D-CRT), in gynecologic malignancy patients by systematic review of the related publications and meta-analysis.
Relevant articles were retrieved from the PubMed, Embase, and Cochrane Library databases up to August 2011. Two independent reviewers assessed the included studies and extracted data. Pooled average percent irradiated volumes of adjacent non-cancerous tissues were calculated and compared between IMRT and 3D-CRT for a range of common radiation doses (5-45 Gy).
In total, 13 articles comprised of 222 IMRT-treated and 233 3D-CRT-treated patients were included. For rectum receiving doses ≥30 Gy, the IMRT pooled average irradiated volumes were less than those from 3D-CRT by 26.40% (30 Gy, p = 0.004), 27.00% (35 Gy, p = 0.040), 37.30% (40 Gy, p = 0.006), and 39.50% (45 Gy, p = 0.002). Reduction in irradiated small bowel was also observed for IMRT-delivered 40 Gy and 45 Gy (by 17.80% (p = 0.043) and 17.30% (p = 0.012), respectively), as compared with 3D-CRT. However, there were no significant differences in the IMRT and 3D-CRT pooled average percent volumes of irradiated small bowel or rectum from lower doses, or in the bladder or bone marrow from any of the doses. IMRT-treated patients did not experience more severe acute or chronic toxicities than 3D-CRT-treated patients.
IMRT-delivered high radiation dose produced significantly less average percent volumes of irradiated rectum and small bowel than 3D-CRT, but did not differentially affect the average percent volumes in the bladder and bone marrow.
通过对相关文献的系统评价和荟萃分析，定量评估调强放疗（IMRT）剂量-体积直方图（DVHs）与传统三维适形放疗（3D-CRT）相比在妇科恶性肿瘤患者中的安全性和相关毒性。
从PubMed、Embase 和 Cochrane Library 数据库中检索到截至 2011 年 8 月的相关文章。两名独立评审员评估纳入的研究并提取数据。计算并比较了 IMRT 和 3D-CRT 治疗的一系列常见辐射剂量（5-45 Gy）下相邻非癌组织的平均受照体积百分比。
共有 13 篇文章纳入 222 例 IMRT 治疗患者和 233 例 3D-CRT 治疗患者。对于接受剂量≥30 Gy 的直肠，IMRT 组的平均受照体积比 3D-CRT 组小 26.40%（30 Gy，p=0.004）、27.00%（35 Gy，p=0.040）、37.30%（40 Gy，p=0.006）和 39.50%（45 Gy，p=0.002）。接受 IMRT 治疗的 40 Gy 和 45 Gy 的小肠受照体积也有所减少（分别减少 17.80%（p=0.043）和 17.30%（p=0.012）），而与 3D-CRT 相比。然而，在较低剂量下，或在任何剂量下，IMRT 和 3D-CRT 的平均受照小肠或直肠体积百分比或膀胱或骨髓均无显著差异。与 3D-CRT 治疗患者相比，接受 IMRT 治疗的患者未经历更严重的急性或慢性毒性。
与 3D-CRT 相比，IMRT 治疗的高剂量辐射显著降低了直肠和小肠的平均受照体积百分比，但对膀胱和骨髓的平均受照体积百分比无差异影响。
