Du X X, Yang H, Zhang H J, Li L A, Fan W S, Meng Y G
Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing 100853, China.
Zhonghua Fu Chan Ke Za Zhi. 2017 Oct 25;52(10):679-686. doi: 10.3760/cma.j.issn.0529-567X.2017.10.007.
To compare the dose, clinical efficacy and acute adverse reactions of intensity modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3D-CRT) combined with three-dimensional brachytherapy (3D-BT) in the treatment of concurrent radiotherapy and chemotherapy for advanced stage cervical cancer patients. Data collection was performed from January 2011 to November 2015 in Chinese PLA General Hospital and Inner Mongolia Cancer Hospital. All 89 patients with advanced stage (Ⅱ b-Ⅲ b) cervical cancer were treated by pelvic radiotherapy and concurrent chemotherapy, 46 cases of them received IMRT and 3D-BT (IMRT group) , 43 cases received 3D-CRT and 3D-BT (3D-CRT group) , along with cisplatin chemotherapy. The dose accumulation of external beam radiotherapy and 3D-BT was calculated by deformable image registration to analyze clinical efficacy, acute adverse reactions and prognosis of the two groups. (1) Dose of radiotherapy: planning target volume (PTV) coverage of IMRT group and 3D-CRT group were respectively (95.4±4.7)% and (95.1±5.1)%, without significant differences (0.289, 0.773). Compared with the patients treated with 3D-CRT, the volumn receiving at least 30 Gy ((30)), (50) of rectum, colon, bladder and small intestine and (20) of bone marrow in the IMRT group were significantly decreased (0.05). Regarding the combined dose, the maximum dose (D(max)) and the minimum dose received by the most exposed 2 cm(3) volume of the analyzed organ (D(2CC)) of rectum, colon, bladder and small intestine of IMRT group were significantly lower than those of 3D-CRT group (0.05). (2) Short-term efficacy: the effective rate of IMRT and 3D-CRT group were respectively 93% (43/46) and 91% (39/43), with no significant differences (χ(2)=0.237, 0.626). (3) Acute adverse reactions: compared with 3D-CRT, IMRT could significantly reduce grade 1-2 acute toxicity in gastrointestinal [63%(29/46) vs 84%(36/43)], genitourinary [17%(8/46) vs 37%(16/43)] and hematologic [57%(26/46) vs 79%(34/43)] system (all 0.05). There were no significant differences of grade 3 acute adverse reactions of gastrointestinal, genitourinary and hematologic system between two groups (all 0.05). No grade 4 acute adverse reactions were observed. (4) Prognosis: the overall survival rate at 1, 2-year of IMRT and 3D-CRT group were respectively 95.6%, 89.1% and 93.1%, 86.1%. The progression-free survival rateat 1, 2-year of IMRT and 3D-CRT group were 91.1%, 89.1% and 88.4%, 86.1%, respectively. There were no significant differences in overall survival rate and progression-free survival rate between two groups (0.05). Compared with 3D-CRT, IMRT combined with 3D-BT has dosimetry advantages based on dose accumulation algorithms by deformable image registration. IMRT could ensure clinical efficacy and significantly reduce the incidence rate of acute toxicities.
比较调强放疗（IMRT）与三维适形放疗（3D-CRT）联合三维近距离放疗（3D-BT）在晚期宫颈癌患者同步放化疗中的剂量、临床疗效及急性不良反应。于2011年1月至2015年11月在中国人民解放军总医院和内蒙古肿瘤医院进行数据收集。89例晚期（Ⅱb-Ⅲb期）宫颈癌患者均接受盆腔放疗及同步化疗，其中46例接受IMRT联合3D-BT（IMRT组），43例接受3D-CRT联合3D-BT（3D-CRT组），同时给予顺铂化疗。通过可变形图像配准计算外照射放疗和3D-BT的剂量累积，以分析两组的临床疗效、急性不良反应及预后。（1）放疗剂量：IMRT组和3D-CRT组的计划靶区（PTV）覆盖率分别为（95.4±4.7）%和（95.1±5.1）%，差异无统计学意义（P=0.289，0.773）。与3D-CRT治疗的患者相比，IMRT组直肠、结肠、膀胱和小肠接受至少30 Gy（V30）、50 Gy（V50）及骨髓接受20 Gy（V20）的体积均显著减小（P<0.05）。就联合剂量而言，IMRT组直肠、结肠、膀胱和小肠的最大剂量（Dmax）及分析器官最受照射的2 cm³体积接受的最小剂量（D2cc）均显著低于3D-CRT组（P<0.05）。（2）近期疗效：IMRT组和3D-CRT组的有效率分别为93%（43/46）和91%（39/43），差异无统计学意义（χ²=0.237，P=0.626）。（3）急性不良反应：与3D-CRT相比，IMRT可显著降低胃肠道[63%（29/46）比84%（36/43）]、泌尿生殖系统[17%（8/46）比37%（16/43）]及血液系统[57%（26/46）比79%（34/43）]1-2级急性毒性反应的发生率（均P<0.05）。两组胃肠道、泌尿生殖系统及血液系统3级急性不良反应发生率差异无统计学意义（均P>0.05）。未观察到4级急性不良反应。（4）预后：IMRT组和3D-CRT组1年、2年总生存率分别为95.6%、89.1%和93.1%、86.1%。IMRT组和3D-CRT组1年、2年无进展生存率分别为91.1%、89.1%和88.4%、86.1%。两组总生存率和无进展生存率差异无统计学意义（P>0.05）。与3D-CRT相比，基于可变形图像配准的剂量累积算法，IMRT联合3D-BT具有剂量学优势。IMRT可确保临床疗效并显著降低急性毒性反应的发生率。
