Chen Fei, Li Jun, Ai Nian, Zhang Huaping, Li Jun, Zhu Yingying
Department of Oncology, Xiaogan Hospital Affiliated to Wuhan University of Science and Technology, Xiaogan, Hubei 432000, P.R. China.
Department of Oncology, The Central Hospital of Xiaogan, Xiaogan, Hubei 432000, P.R. China.
Oncol Lett. 2019 Mar;17(3):3432-3438. doi: 10.3892/ol.2019.9989. Epub 2019 Jan 29.
Clinical efficacy in patients with cervical and upper thoracic esophageal cancer was compared between three-dimensional conformal radiotherapy (3D-CRT) and conformal intensity-modulated radiotherapy (IMRT). Medical data of 120 esophageal cancer patients undergoing RT in the Radiology Department in Xiaogan Hospital Affiliated to Wuhan University of Science and Technology (Xiaogan, China) from March 2015 to March 2018 were retrospectively analyzed. Patients were divided into 3D-CRT group (treated with 3D-CRT, n=60) and IMRT group (treated with IMRT, n=60). The target conformal index (CI), PTV maximum dose (D), PTV D and PTV D in both groups were observed. Changes in double-lung V5, double-lung V20, double-lung V30 and spinal cord D in both groups were also observed. The serum free triiodothyronine (FT3), free tetraiodothyronine (FT4) and thyroid-stimulating hormone (TSH) concentrations were detected via chemiluminescence assay. Moreover, the short-term efficacy and radiation injury were observed. CI in IMRT group was significantly higher than that in 3D-CRT group (P<0.001). The organ-at-risk dose parameter V20 in IMRT group was obviously lower than that in 3D-CRT group (P<0.001). Serum FT3 and FT4 concentrations in both groups before RT were significantly higher than those after RT (P<0.05), but the TSH concentration was significantly lower than that after RT (P<0.05). Serum FT3 and FT4 concentrations in IMRT group after RT were obviously higher than those in 3D-CRT group (P<0.05). The incidence rates of radiation esophagitis and radiation pneumonitis in IMRT group were remarkably lower than those in 3D-CRT group (P<0.05). IMRT can reduce the double-lung V20 in patients, improve the target conformal degree, better protect the normal tissues, cause less damage to thyroid function, and reduce radiation injury during and after RT of esophageal cancer.
比较三维适形放疗（3D-CRT）与调强适形放疗（IMRT）治疗颈段和胸上段食管癌患者的临床疗效。回顾性分析2015年3月至2018年3月在武汉大学附属孝感医院放射科接受放疗的120例食管癌患者的医学资料。将患者分为3D-CRT组（接受3D-CRT治疗，n=60）和IMRT组（接受IMRT治疗，n=60）。观察两组的靶区适形指数（CI）、计划靶区（PTV）最大剂量（D）、PTV平均剂量（Dmean）和PTV最小剂量（Dmin）。同时观察两组双肺V5、双肺V20、双肺V30和脊髓D的变化。采用化学发光法检测血清游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）和促甲状腺激素（TSH）浓度。此外，观察短期疗效和放射性损伤。IMRT组的CI明显高于3D-CRT组（P<0.001）。IMRT组的危及器官剂量参数V20明显低于3D-CRT组（P<0.001）。两组放疗前血清FT3和FT4浓度均明显高于放疗后（P<0.05），但TSH浓度明显低于放疗后（P<0.05）。IMRT组放疗后血清FT3和FT4浓度明显高于3D-CRT组（P<0.05）。IMRT组放射性食管炎和放射性肺炎的发生率明显低于3D-CRT组（P<0.05）。IMRT可降低患者双肺V20，提高靶区适形度，更好地保护正常组织，对甲状腺功能损伤较小，并减少食管癌放疗期间及放疗后的放射性损伤。
