摘要
目的回顾性分析宫颈癌调强放射治疗（intensity-modulated radiation therapy，IMRT）中急性放射性直肠炎的发生与直肠受照剂量、体积以及受照时间关系。方法收集本院2011年1月至2013年12月行IMRT照射的51例宫颈癌病例，根据RTOG／EORTC毒性分级标准分为1～4级。用剂量体积直方图（DVH）评价标准计划下不同放射性直肠炎分级组的患者直肠受照剂量体积。分析直肠Dmax、Dmean、D1cm、J2cm，、D40、V40和出现症状时直肠受照剂量。结果急性放射性直肠炎发生的平均时间为放疗后（23．06±12．01）d。与发生放射性直肠炎3—4级组相比，放射性直肠炎2级组的直肠Dmax值更低，差异有统计学意义（F=5．268，P〈0．05）；与发生放射性直肠炎3～4级组相比，放射性直肠炎1级、2级组的直肠D，甜、D2cm，值均低于放射性直肠炎3～4级组（F=4．893、4．406，P〈0．05），而直肠D40和V40值的差异无统计学意义（P〉0．05）。结论宫颈癌患者IMRT放疗20d左右较易发生急性放射性直肠炎，且较多发生轻度到中度急性放射性直肠炎，重度急性放射性直肠炎的发生率低。在宫颈癌IMRT放疗时，尽量减小直肠Dmax、D1cm3、D2cm3的值，对降低重度急性放射性直肠炎的发生率有意义。
Objective To investigate the relationship between acute radiation proctitis and radiation dose, volume as well as radiation time, in the process of intensity-modulated radiation therapy （IMRT） for the cervical cancer patients. Methods A total of 51 patients with locally advanced cervical cancer were enrolled from January 2011 to December 2013. Those patients were then classified into grade 1 to 4 groups, according to the RTOG/EORTC toxicity grading standard. The exposure dose volume and the average dose of rectum under the standard plan were evaluated with close-volume histogram （ DVH）. The ANOVA test was used for analyzing D D Dl cm3, D2 om3, D40 and V40 values of rectum and the average exposure dose of rectum. Results The average time of acute radiation proetitis with clinical symptoms was （23.06± 12.01 ） d after radiotherapy. Dmax values of rectum in grade 2 group was lower than those in grade 3 and4 groups （F=5.268, P〈0.05）. Moreover, D1cm3 and D2cm3 values of rectum in grade 1 and 2 groups were also lower than those in grade 3 and 4 groups （ F = 4. 893, 4.406, P 〈 0.05）. There was no statistically significant difference between D40 and V40 values. Conclusions The acute radiation proetitis could be frequently found around 20 days during the IMRT for cervical cancer patients. Mild and moderate acute radiation proctitis are more common, while severe acute radiation proctitis is rare. Minimizing D D1cm3 and D2c m3 values of rectum might reduce the incidence of severe acute radiation proetitis in cervical cancer patients receiving IMRT.
作者
郑敏
何玲
许敬辉
马家宝
范羽
谢非
刘光荣
樊伶俐
王捷
Zheng M Xu JH Ma JB Fan Y Liu GR Wang J He L Fan LL Xie F(Sichuan Cancer Hospital, Chengdu 610041, China Sichuan Province Center for Disease Control and Prevention, Chengdu 610041, China Mianyang Central Hospital of Sichuan Province, Mianyang 612000, China Deyang People＇s Hospital of Sichuan Province, Deyang 618000, China)
出处
《中华放射医学与防护杂志》
CAS
CSCD
北大核心
2017年第3期205-209,共5页
Chinese Journal of Radiological Medicine and Protection
关键词
宫颈癌
适形调强放疗
外照射
急性放射性直肠炎
Cervical cancer
Intensity-modulated radiation therapy
External beam radiotherapy
Acute radiation proctitis
