摘要
目的 探讨调强适形放射治疗（IMRT）在妇科恶性肿瘤患者术后治疗中的效果及价值。方法 32例子宫颈癌、子宫内膜癌术后患者（KPS≥70）在放疗前均行1～3个周期的化疗，而后给予全程IMRT。其中17例为术后、化疗后预防性照射，15例为术后、放疗和（或）化疗后腹膜后淋巴结转移和（或）盆腔壁复发的放疗。结果 32例患者均完成全程放射治疗，预防性照射的计划靶区（PTV）中位剂量为56．8Gy；腹膜后淋巴结转移、盆壁复发的胛V中位剂量为60．6Gy，90％的等剂量曲线可以覆盖99％以上的肉眼肿瘤靶区（GTV）体积。小肠、膀胱、直肠、肾脏和脊髓的中位剂量分别为21．3Gy、37．8Gy、35．3Gy、8．5Gy和22．1Gy。14例患者出现Ⅰ～Ⅱ级消化道反应，其中Ⅱ级反应者3例，I级反应者11例；5例出现Ⅰ～Ⅱ度骨髓抑制；12例出现Ⅰ级皮肤反应。1年生存率为100％。预防性照射的2、3年生存率均为100％；腹膜后淋巴结转移和（或）盆腔壁复发患者的2、3年生存分别为5／7和3／6。结论 IMRT对妇科恶性肿瘤术后患者的预防性照射和复发患者的放疗均可获得理想的剂量分布，邻近危险器官得到保护，临床近期疗效满意。
Objective To investigate the value of intensity modulated radiation therapy （IMRT） for patient with gynecological malignancies after treatment of hysterectomy and chemotherapy/radiotherapy. Methods All 32 patients with cervical or endometrial cancer after hysterectomy received full course IMRT after 1 to 3 cycles of chemotherapy （Karnofsky performance status（KPS）≥70）. Seventeen of these patients underwent postoperative preventive irradiation and the other 15 patients were pelvic wall recurrence and/or retroperitoneal lymph node metastasis, though postoperative radiotherapy and/or chemotherapy had been given after operation. Results The median dose delivered to the PIN was 56.8 Gy for preventive irradiation, and 60.6 Gy for pelvic wall recurrence or retroperioneal lymph node metastasis irradiation. It was required that 90% of iso-dose curve could covere more than 99% of GTV. However, The mean dose irradiated to small intestine, bladder, rectum, kidney and spinal cord was 21.3 Gy, 37.8 Gy, 35.3 Gy, 8.5 Gy, 22.1 Gy, respectively. Fourteen patients presented grade Ⅰ （11 patients） or Ⅱ（3 patients ） digestive tract side- effects, Five patients developed grade Ⅰ or Ⅱ bone marrow depression. Twelve patients had gradeⅠ skin reaction. The overall 1-year survival rate was 100%. The 2- and 3- year survival rate for preventive irradiation were both 100%, but which was 5/7 and 3/6 for the patients with pelvic wall recurrence or retroperioneal lymph node metastasis. Conclusion Intensity modulated radiation therapy can provide a better dose distribution than traditional radiotherapy for both prevention and pelvic wall recurrence or retroperioneal lymph node metastasis. The toxicity is tolerable. The adjacent organs at risk can well be protected.
出处
《中华肿瘤杂志》
CAS
CSCD
北大核心
2007年第4期305-308,共4页
Chinese Journal of Oncology
