【摘要】 目的 探讨三维腔内后装同步体外施源器引导调强放疗技术(ICBT+IMRT与三维腔内联合组织间插植技术（IC/IS-BT）在局部晚期宫颈癌患者治疗中的剂量学差异。方法 回顾性分析2015年3月至2018年8月医院收治的105例接受三维腔内后装放疗的局部晚期宫颈癌患者的临床资料，根据不同腔内后装补量方式分为ICBT+IMRT组52例和IC/IS-BT组53例，比较两组肿瘤靶区（HR-CTV）和危及器官（OARs）的剂量学差异。结果 ICBT+IMRT组和IC/IS-BT组的靶区体积比较，差异无统计学意义（P> 0.05）;ICBT+IMRT组的HR-CTV靶区覆盖度D₁₀₀优于IC/IS-BT组，差异有统计学意义（P <0.05）；两组的HR-CTV靶区覆盖度D₉₀比较，差异无统计学意义（P> 0.05）。ICBT+IMRT组的膀胱D_1cc剂量略低于IC/IS-BT组，差异有统计学意义（P <0.05），但两组膀胱D_2cc剂量比较，差异无统计学意义（P>0.05）;ICBT+IMRT的直肠受量(D_1cc、D_2cc)均高于IC/IS-BT组，差异有统计学意义（P<0.05）。结论 ICBT+IMRT组与IC/IS-BT组的肿瘤靶区剂量均能满足处方剂量要求，且靶区覆盖较好。虽然ICBT+IMRT组直肠受量稍高于IC/IS-BT组，但ICBT+IMRT补量技术具有操作简便、避免因插植针拔出后出血及感染的风险等优势，因此可作为IC/IS-BT技术组的补充或替代手段。更多还原

【Abstract】 Objective The dosimetric variance of 3D high-dose-rate （HDR）intracavitary brachytherapy （ICBT） in combination with intensity modulated radiation therapy（IMRT） boost technique （ICBT+IMRT） and intracavitary/interstitial （IC/IS） brachytherapy （BT）boost technique （IC/IS-BT） for locally advanced cervix carcinoma patients was explored.Methods A total of 105 patients with locally advanced cervical cancer treated in hospital from March 2015 to August 2018 were divided into two groups according to the different boost techniques:52 patients treated with ICBT+IMRT boost technique were set as ICBT+IMRT group,and the other 53patients treated with IC/IS-BT boost technique were set as IC/IS-BT group.Dosimetry differences of target and organs at risk were evaluated for the two different boost techniques.Results There was no statistically significant difference in target volume between the ICBT+IMRT group and the IC/IS-BT group （P>0.05）;The HR-CTV target coverage D₁₀₀ in the ICBT+IMRT group was better than that in the IC/IS-BT group,with a statistically significant difference （P<0.05）;There was no statistically significant difference in the HR-CTV target coverage D₉₀ between the two groups of patients（P>0.05）. The bladder D_1cc dose in the ICBT+IMRT group was slightly lower than that in the IC/IS-BT group, with a statistically significant difference（P < 0.05）. However, there was no statistically significant difference in bladder D_2cc dose between the two groups（P>0.05）; The rectal receptivity(D_1cc, D_2cc) of ICBT+IMRT was higher than that of IC/IS-BT group, and the difference was statistically significant（P<0.05）. Conclusions The tumor target dose of ICBT+IMRT group and IC/IS-BT group could meet the prescription dose requirements and provide good target coverage. Although, ICBT+IMRT plan increased the dose of rectum, it is easy to operate and able to avoid the risk of bleeding and infection due to the insertion of the implant needle removal. ICBT+IMRT is a complementary or alternative technique to boost parametrial region or tumor of large size and irregular shape when IC/IS-BT cannot be used. The clinical efficacy and adverse effects of the two different boost techniques in brachytherapy for locally advanced cervical cancer still need to be further investigated.更多还原