肿瘤预防与治疗2017，Vol.30Issue(4)：247-253,7.DOI:10.3969/j.issn.1674-0904.2017.04.002
局部晚期宫颈癌自适应放疗剂量学及生存分析与毒性反应评价
Dosimetric Change, Survival and Toxicities Study for Locally Advanced Cervix Carcinoma Treated with Adaptive Radiotherapy (ART) during External Beam Radiotherapy (EBRT)
摘要
Abstract
Objective:To evaluate dosimetric change in organs at risk (OARs),clinical effect and toxicities of ART for locally advanced cervical carcinoma by comparing single-course intensity modulated radiotherapy during EBRT.Methods:A total of 112 locally advanced (FIGO Stage ⅡB-ⅣA) cervical cancer cases receiving concurrent radiochemotherapy in our hospital from May 2010 to May 2015 were enrolled in this study.Patients were divided into two groups according to their EBRT mode,including group A accepted single-course radiotherapy (n =62) and group B accepted adaptive radiotherapy(ART) (n =50).Patients in Group B received 15 fractions EBRT using the first course plan(plan1),then received 10 subsequent fractions radiation using redesigned adaptive plan (Plan2).Intensity modulated radiation therapy (IMRT) was adopted for external radiation in both groups.IMRT synchronized dosage compensation 3D-intracvitary brachytherapy(3D-ICBT) with high dosage rate was adopted after EBRT in both groups.In addition,concurrent chemotherapy with weekly cisplatin was administered to patients in both groups.For the first stage,radiotherapy regimens of two plans in Group B were compared to determine volume change of tumor and dosimetric change of OARs.For the second stage,patients were followed up to compare survival conditions and occurrences of toxicity between the two groups.Results:Average tumor volume was decreased from (107.67 ± 32.02) cm3 to (63.21 ± 25.78) cm3 after 15 fractions of EBRT with an average reduction rate of (35.48 ± 5.16) ％ (P ＜ 0.05)in Group B.Dose-volume histogram (DVH) showed that the values of Dmax,Dmean,D1 cc of rectum and bladder in plan 2 were significantly decreased(P ＜ 0.05) in comparison to those in plan1.The incidence of acute diarrhea in group A was significantly higher than that in Group B (48.39％ vs.30％,P =0.046),while no significant differences was found of the incidence of other acute and chronic toxicities between these two groups.The 3-year overall survival(OS) was 90.9％ and 95.2％ in group A and B,respectively (P ＞ 0.05).The 3-year progress free survival(PFS) was 80.4％ and 93.2％ in group A and v group B,respectively (P ＞ 0.05).Conclusion:The tumor volume decreases obviously during EBRT process for the locally advanced cervical carcinoma.Both therapy modes of EBRT can bring favorable therapeutic effects.Implementation of ART during EBRT might reduce irradiated dosages in rectum and bladder as well as reduce the occurrence of acute diarrhea of patients.关键词
局部晚期宫颈癌/体外放疗/自适应放疗/剂量学/毒性反应/预后Key words
Locally advanced cervical cancer/External beam radiotherapy (EBRT)/Adaptive radiotherapy (ART)/Dosimetry/Toxicity/Prognosis分类
医药卫生引用本文复制引用
阴骏,李鹏程,范子煊,冯梅,吴凡,秦远,王培,郎锦义..局部晚期宫颈癌自适应放疗剂量学及生存分析与毒性反应评价[J].肿瘤预防与治疗,2017,30(4):247-253,7.基金项目
四川省科技厅科技支撑计划(编号:2014SZ0001) （编号:2014SZ0001）
四川省科技厅应用基础项目(编号:2016JY0135) （编号:2016JY0135）
