Effect factors of acute radiation proctitis caused by intensity modulated radiotherapy for cervical cancer
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摘要:
目的探讨宫颈癌放射治疗急性放射性直肠炎发生的相关因素,为提高患者治疗耐受性,改善生存率提供参考指标。 方法收集我科2013年3月~2015年5月收治的宫颈癌患者80例,其中术后放疗者55例,未行手术者25例;临床分期Ⅰ期30例,Ⅱ期37例,Ⅲ期13例;80例患者均接受体外调强放疗及腔内后装放疗。体外调强放疗处方剂量45~50 Gy/25次,单次1.8~2.0 Gy,若有肿大淋巴结,则给予同步加量至60~70 Gy。后装腔内放疗采用高剂量率后装治疗机进行,未手术患者放疗剂量35~42 Gy/6~7次,单次5~6 Gy,术后放疗患者放疗剂量为15 Gy/3次,单次5 Gy。变量间的相关性分析采用Spearman相关性检验,组间的比较采用χ2检验,采用Logistic Forward方法进行多元回归分析。 结果本组80例患者中,急性放射性直肠炎发生率为57.5%(46/80),其中Ⅰ级急性放射性直肠炎发生率为46.25%(37例),Ⅱ级急性放射性直肠炎发生率为11.25%(9/80),未出现Ⅲ、Ⅳ级急性放射性直肠炎。单因素分析显示直肠mean、直肠V30、V35、V40、V50与急性放射性直肠炎的发生均有显著性影响。其中直肠V40为影响急性放射性直肠炎发生的独立性因素。 结论宫颈癌调强放疗直肠V40为急性放射性直肠炎发生的主要影响因素。 Abstract:ObjectiveTo analyze the effect factors of acute radiation proctitis caused by intensity modulated radiotherapy for cervical cancer. MethodsFrom march 2013 to may 2015, 80 cervical cancer patients were received intensity modulated radiotherapy and eligible for this study. In all the patients, 55 patients accepted operation, the other 25 patients did not accepted operation before radiation therapy. Clinical stage I of 30 cases, stage Ⅱ of 37 cases, stage III of 13 cases; 80 patients received treatment of intensity modulated radiotherapy and post irradiation. All of the patients received the biological effective dose (BED) between 45-50 Gy. If there was swollen lymph nodes, then given the synchronization to 60-70 Gy. Intracavitary radiotherapy with high dose rate afterloading machine, The dose of radiotherapy of the patients without surgery was 35-42 Gy/6-7 times, single 5-6 Gy, The dose of radiotherapy of the patients with surgery was 15 Gy/3 times, single 5 Gy. The correlation of every variable were evaluated by spearman relationship analysis. The rate of irradiated pneumonitis was analyzed by χ2 test, the multivariate effect on irradiated pneumonitis was statisticed by Logistic regression model. ResultsIn the 80 patients, rate of acute radiation proctitis was 57.5%, and the rate of 1 degree was 46.25%, the rate of 2 degree was 11.25%, no degree Ⅲ、IV acute radiation proctitis Univariate analysis showed rectal average dose、rectal V30、V35、V40、V50 were important effect factors for acute radiation proctitis. Father more, rectal V40 was likely to be the independent factors of acute radiation proctitis by logistic model. ConclusionRectal V40 is the independent effect factor of acute radiation proctitis. -
Key words:
- cervical cancer /
- intensity modulated radiotherapy /
- acute radiation proctitis /
- DVH
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表 1 急性放射性直肠炎发生的相关因素
物理参数 r P 直肠mean 0.454 0.000 直肠V35 0.668 0.000 直肠V45 0.398 0.000 直肠V30 0.424 0.000 直肠V40 0.579 0.000 直肠V50 0.393 0.007 表 2 治疗计划物理参数与急性放射性直肠炎发生的单因素分析
参数指标 例数 放射性直肠炎发生率(%) χ2 P 0 级(例数) 1 级(例数) 2 级(例数) 直肠mean(Gy) 65.185 0.000 <40 68 50%(34) 50%(34) 0%(0) ≥40 12 0%(0) 16.7%(2) 83.3%(10) 直肠V30(%) 10.771 0.005 <80 17 76.5%(13) 23.5%(4) 0%(0) ≥80 63 33.3%(21) 50.8%(32) 15.9%(10) 直肠V35(%) 28.931 0.000 <60 32 78.1%(25) 21.9%(7) 0%(0) ≥60 48 18.8%(9) 60.4%(29) 20.8%(10) 直肠V40(%) 30.599 0.000 <40 56 55.4%(31) 44.6%(25) 0%(0) ≥40 24 12.5%(3) 45.8%(11) 41.7%(10) 直肠V50(%) 7.100 0.029 <10 67 47.8%(32) 43.3%(29) 8.9%(6) ≥10 13 15.4%(2) 53.8%(7) 30.8%(4) -
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