DU Xue-lian, Sheng Xiu-gui, Wang Cong, Yu Hao, Song Qu-qing, Pan Chun-xia
Department of Gynecologic Oncology, Shandong Cancer Hospital, Jinan 250117, China.
Department of Gynecologic Oncology, Shandong Cancer Hospital, Jinan 250117, China. Email:
Zhonghua Zhong Liu Za Zhi. 2013 Dec;35(12):925-31.
To explore the clinical value and efficacy of reduced field intensity modulated radiation therapy (RF-IMRT) for patients with advanced cervical cancer.
Seventy-one patients with stage IIB-IIIB cervical cancer, who underwent reduced field IMRT (RF-IMRT group) and 72 patients treated with conventional radiotherapy (c-RT group) in Shandong Cancer Hospital between 2005 August and 2011 August, were enrolled in this study. The RF-IMRT plans were as follows: whole pelvic IMRT plan was performed to deliver an initial dose of 30 Gy, then the irradiated volume was reduced to lymphatic drainage region as well as paracervix and parametrium for an additional 30 Gy boost. Conventional 2-field RT plan was performed in these patients using ADAC Pinnacle 3 planning system, to be given the same prescription dose, and to compare the irradiation dose of organs at risk (OARs). At the same time, conventional 2-field RT was performed in 72 patients of the c-RT group. Concurrent chemotherapy and intracavitary brachytherapy were also performed in the two groups. The treatment response, toxicities, normal tissue avoidance, and survival were assessed.
Sixty-six patients of the RF-IMRT group and 65 patients of the c-RT group fulfilled the treatment plan. IMRT plans yielded better dose conformity to the target (0.711 ± 0.057 vs. 0.525 ± 0.062, P = 0.032) and better sparing of the rectum, bladder and small intestine (rectum: 41.6 ± 6.8 vs. 50.8 ± 3.2, P = 0.016; bladder: 40.2 ± 2.9 vs. 51.4 ± 1.8, P = 0.007; small intestine: 22.3 ± 2.6 vs. 35.8 ± 3.9, P = 0.004). The mean dose delivered to the planning target volume (PTV) was significantly higher in the RF-IMRT group than that in the c-RT group (60.8 vs. 51.2 Gy, P = 0.006). The RF-IMRT patients experienced significantly lower acute and chronic toxicities with comparable short-term effects than did those treated with conventional RT (P > 0.05). No significant differences were found between the two groups for 1-, 3-, and 5-year overall survival (OS) rates, while a significantly higher progression-free survival (PFS, 65.2% vs. 46.2%, P = 0.031) rate was observed in the RF-IMRT group.
RF-IMRT yields higher dose distributions and lower toxicities compared with conventional RT, and both the tumor target volume and pelvic lymphatic drainage region achieve curative dose irradiation, the adjacent organs at risk are well protected, and with tolerable adverse reactions. Yet, RF-IMRT provides comparable clinical outcomes and higher PFS.
探讨缩野调强放射治疗（RF-IMRT）在晚期宫颈癌患者中的临床价值及疗效。
选取2005年8月至2011年8月在山东省肿瘤医院接受治疗的71例IIB-IIIB期宫颈癌患者作为缩野调强放射治疗组（RF-IMRT组），72例接受传统放疗的患者作为传统放疗组（c-RT组）。RF-IMRT计划如下：先进行全盆腔调强放射治疗计划，给予初始剂量30 Gy，然后将照射野缩小至淋巴引流区以及宫颈旁和子宫旁组织，追加30 Gy的剂量。使用ADAC Pinnacle 3计划系统对这些患者进行传统的两野放疗计划，给予相同的处方剂量，并比较危及器官（OARs）的照射剂量。同时，对c-RT组的72例患者进行传统两野放疗。两组均同时进行化疗和腔内近距离放疗。评估治疗反应、毒性、正常组织保护情况及生存率。
RF-IMRT组66例患者和c-RT组65例患者完成了治疗计划。调强放射治疗计划对靶区的剂量适形性更好（0.711±0.057 vs. 0.525±0.062，P = 0.032），对直肠、膀胱和小肠的保护更好（直肠：41.6±6.8 vs. 50.8±3.2，P = 0.016；膀胱：40.2±2.9 vs. 51.4±1.8，P = 0.007；小肠：22.3±2.6 vs. 35.8±3.9，P = 0.004）。RF-IMRT组给予计划靶区（PTV）的平均剂量显著高于c-RT组（60.8 vs. 51.2 Gy，P = 0.006）。与接受传统放疗的患者相比，RF-IMRT患者的急性和慢性毒性显著更低，短期疗效相当（P>0.05）。两组的1年、3年和5年总生存率（OS）无显著差异，但RF-IMRT组的无进展生存率（PFS，65.2% vs. 46.2%，P = 0.031）显著更高。
与传统放疗相比，RF-IMRT具有更高的剂量分布和更低的毒性，肿瘤靶区体积和盆腔淋巴引流区均达到根治性剂量照射，对相邻危及器官保护良好，不良反应可耐受。然而，RF-IMRT提供了相当的临床疗效和更高的PFS。
