【作者】 于浩；

【导师】 刘培淑；

【作者基本信息】 山东大学 ， 妇产科学（专业学位）， 2017， 博士

【摘要】 [研究背景]子宫颈癌是妇科最常见的恶性肿瘤之一,是仅次于乳腺癌的全球第二位女性恶性肿瘤。目前我国每年有新发子宫颈癌例约10万左右,并且呈现发病年轻化的趋势。子宫颈癌采用国际妇产科联盟(International Federation of Gynecology and Obstetrics,FIGO)分期。对于局部晚期子宫颈癌患者,美国国立综合癌症网络(National Comprehensive Cancer Network,NCCN)指南推荐同步放化疗作为其标准治疗方案。子宫颈癌的放射治疗包括体外放疗和腔内放疗。传统体外盆腔放疗后严重放射性反应如放射性直肠炎和放射性膀胱炎发生率达到35-40%。随着影像和计算机技术的进步,自上世纪90年代开始,精确放疗技术如三维适形和调强放疗得到广泛应用。调强放射治疗(Intensity-modulated radiation therapy,IMRT)在实现照射野形状与靶区一致的基础上,通过调整照射野内剂量,达到剂量分布与靶区一致。螺旋断层放射治疗(Helical tomotherapy,HT)是一种图像引导调强放射治疗技术,其融合CT和加速器,360度旋转照射,实现剂量分布的高度适形性和均匀性。同时每次放疗前均可进行MVCT图像校准,降低摆位误差,实现精准放疗。腔内放疗是子宫颈癌治疗中必不可少的治疗手段。传统腔内放疗是二维后装治疗(Two dimensional intracavitary brachytherapy)。由于二维剂量系统的局限性如:无法根据肿瘤体积变化调整靶区大小;无法准确评估危及器官膀胱和直肠的受量;A点剂量评估不准确;近距离放射治疗距离-剂量反比定律导致靶区内剂量分布不均匀等。2000年以来,以CT或MRI为基础的三维后装治疗(Three dimensional intracavitary brachytherapy)逐渐应用于临床,实现了腔内放疗的精确治疗。我院(山东省肿瘤医院)自2012年开始应用CT引导三维(核通)腔内放疗(Three dimensional CT-based intracavitary brachytherapy,CT-ICBT)治疗子宫颈癌。2014年开始应用HT治疗子宫颈癌。本论文旨在通过剂量学和临床学研究,探讨HT联合CT-ICBT在局部晚期子宫颈癌中的治疗意义,评估其不良反应发生率和近期疗效。第一部分HT与IMRT PTV和危及器官剂量学分析[摘要][研究目的]比较HT与IMRTPTV和危及器官剂量学差异。[研究方法]回顾性分析我院2014年(1月-12月)治疗的局部晚期(ⅡB-ⅢB)子宫颈癌患者,共47例,治疗方式均为同步放化疗。化疗方式为:紫杉醇+顺铂三周方案。根据体外放射和腔内放射治疗方式不同,分为HT+CT-ICBT组22例;IMRT+ICBT组25例。体外放射治疗分为HT和IMRT。体外放疗采用缩野治疗方式,即体外全盆腔放疗DT:2880cGy,后缩野照射淋巴结引流区和宫旁组织DT:2160cGy。体外放疗靶区勾画参考美国放射治疗学组(Radiation Therapy Oncology Group,RTOG)未手术者勾画指南 Int.J.Radiation Oncology Biol.Phys.2010。比较全盆腔体外放射治疗(2880cGy)时HT和IMRTPTV和危及器官剂量学差异,比较适形指数(Conformity,CI)和均匀指数(Homogeneity,HI)差异;比较缩野后体外放射治疗(2160cGy)时RF-HT与RF-IMRTPTV和危及器官剂量学差异,比较CI和HI差异;比较全盆腔体外放射治疗(2880cGy)和缩野后体外放射治疗(2160cGy)计划融合后危及器官平均受量差异。[研究结果]1.全盆腔体外放射治疗(2880cGy)。①HT和IMRT PTV剂量学比较:HT计划PTV 平均剂量 Dmean(Gy):29.72±4.02;IMRT 计划 PTV 平均剂量 Dmean(Gy):30.31±3.63,差异无统计学意义(P=0.599)。HT计划105%等剂量曲线PTV105%(cm3):9.80±2.26;IMRT 计划 105%等剂量曲线 PTV105%(cm3):10.31 ±2.06,差异无统计学意义(P=0.422)。HT和IMRT计划110%等剂量曲线PTV 110%(cm3)均为 0。HT 计划 CI:0.787±0.216;IMRT 计划 CI:0.656±0.221,HI 计划 CI优于IMRT计划,差异有统计学意义(P=0.046)。HT计划HI:1.069±0.198;IMRT计划HI:1.085±0.176,差异无统计学意义(P=0.770)。②危及器官受量剂量学比较:V40(%):直肠 HT:42.33±7.20;IMRT:49.68±7.94(P=0.001)。膀胱HT:33.91 ±6.82;IMRT:39.23±8.01(P=0.001)。小肠 HT:6.05± 1.56;IMRT:7.19±2.02(P=0.037)。右股骨头 HT:2.56±0.56;IMRT:2.93±0.52(P=0.721)。左股骨头 HT:3.01±0.68;IMRT:3.31±0.59(P=0.112)。HT 计划直肠、膀胱和小肠V40(%)小于IMRT计划,差异均有统计学意义。HT计划和IMRT计划左右股骨头V40(%)差异无统计学意义。Dmean(Gy):直肠HT:20.29±3.40;IMRT:23.07±4.85(P=0.029)。膀胱 HT:17.95±5.34;IMRT:20.99±4.92(P=0.048)。小肠 HT:13.74±3.02;IMRT:15.55±2.91(P=0.042)。右股骨头 HT:12.27±3.06;IMRT:12.84±3.85(P=0.580)。左股骨头 HT:11.89±3.21;IMRT:12.92±1.45(P=0.154)0HT 计划直肠、膀胱和小肠 Dmean(Gy)小于IMRT计划,差异均有统计学意义。HT计划和IMRT计划左右股骨头Dmean(Gy)差异无统计学意义。2.缩野后体外放射治疗(2160cGy)。①RF-HT与RF-IMRT PTV剂量学比较:RF-HT 计划 PTV 平均剂量 Dmean(Gy):22.25±5.12;RF-IMRT 计划 PTV 平均剂量 Dmean(Gy):22.73士3.41,差异无统计学意义(P=0.703)。RF-HT 和 RF-IMRT计划105%等剂量曲线PTV110%(cm3)均为0。RF-HT和RF-IMRT计划110%等剂量曲线 PTV110%(cm3)均为0。RF-HT 计划 CI:0.800±0.202;RF-IMRT计划CI:0.660±0.254,RF-HI计划CI优于RF-IMRT计划,差异有统计学意义(P=0.044)。RF-HT 计划 HI:1.049±0.230;RF-IMRT 计划 HI:1.051 ±0.147,差异无统计学意义(P=0.972)。②危及器官受量:V40(%):直肠RF-HT:5.68±0.48;RF-IMRT:9.60± 1.53(P=0.000)。膀胱 RF-HT:20.54±4.92;RF-IMRT:26.68 ± 3.46(P=0.000)。小肠 RF-HT:5.97± 0.44;RF-IMRT:6.17 ± 1.17(P=0.454)。右股骨头 RF-HT:3.03±0.36;RF-IMRT:2.92±0.18(P=0.184)。左股骨头 RF-HT:3.18±0.30;RF-IMRT:2.84±0.56(P=0.062)。RF-HT 计划直肠和膀胱 V40(%)小于RF-IMRT计划,差异均有统计学意义。RF-HT计划和RF-IMRT计划小肠、左右股骨头V40(%)差异无统计学意义。Dmean(Gy):直肠RF-HT:11.57±2.22;RF-IMRT:13.09±1.98(P=0.016)。膀胱 RF-HT:12.87±2.58;RF-IMRT:14.66±3.02(P=0.035)。小肠 RF-HT:10.48±1.53;RF-IMRT:10.91 ±2.66(P=0.508)。右股骨头 RF-HT:8.40± 1.76;RF-IMRT:8.10±2.26(P=0.617)。左股骨头 RF-HT:8.49± 1.02;RF-IMRT:7.91 ±1.20(P=0.083)。RF-HT 计划直肠和膀胱Dmean(Gy)小于RF-IMRT计划,差异均有统计学意义。RF-HT计划和RF-IMRT计划小肠、左右股骨头Dmean(Gy)差异无统计学意义。3.全盆腔体外放射治疗(2880cGy)和缩野后体外放射治疗(2160cGy)计划融合后危及器官平均受量Dmean(Gy)。直肠HT:32.06 ± 6.82;IMRT:35.39 ±3.97(P=0.043)。膀胱HT:30.14± 7.97;IMRT:34.17 ± 4.86(P=0.039)。小肠 HT:24.20 ± 3.60;IMRT:26.47 ± 3.90(P=0.044)。右股骨头 HT:20.38± 2.22;IMRT:21.24 ± 3.45(P=0.304)。左股骨头 HT:19.60 ± 3.61;IMRT:22.41 ± 3.09(P=0.070)。全盆腔体外放射治疗(2880cGy)和缩野后体外放射治疗(2160cGy)计划融合后直肠、膀胱和小肠平均受量Dmean(Gy),HT计划低于IMRT计划,差异有统计学意义;左右股骨头差异无统计学意义。[研究结论]1.体外放疗HT计划和IMRT计划均能实现良好的PTV覆盖,但HT计划CI优于IMRT计划。2.HT计划危及器官直肠、膀胱和小肠V40(%)和Dmean均低于IMRT计划。第二部分CT-ICBT和ICBT剂量曲线和危及器官受量分析[摘要][研究目的]比较CT-ICBT和ICBT剂量曲线和危及器官受量差异。[研究方法]回顾性分析我院2014年(1月-12月)治疗的局部晚期(ⅡB-ⅢB)子宫颈癌患者,共47例,治疗方式均为同步放化疗。化疗方式为:紫杉醇+顺铂三周方案。根据体外放射和腔内放射治疗方式不同,分为HT+CT-ICBT组22例;IMRT+ ICBT组25例。腔内放射治疗分为CT-ICBT和ICBT。A点剂量均为4500-5000cGy。CT-ICBT 以 90%High Risk CTV(HR-CTV)剂量(D90)>处方剂量(500cGy)制定计划。参考 ESTRO 工作组(Working group European Society for Radiotherapy&Oncology,ESTRO)三维后装治疗靶区、危及器官勾画、靶区重建和优化指标指南。二维(荣力)腔内放疗处方剂量为A点500cGy。描述CT-ICBT计划下剂量曲线、直肠铅丝剂量、膀胱和直肠ICRU剂量;描述ICBT计划(A点500cGy)剂量曲线、直肠铅丝剂量、膀胱和直肠ICRU剂量;比较CT-ICBT三维计划和二维计划剂量曲线、危及器官膀胱和直肠总剂量差异(A点累积剂量45-50Gy)。[研究结果]1.ICBT计划(A点500cGy)膀胱、直肠ICRU剂量和直肠铅丝剂量。Rectom-DICRU(Gy):3.14±0.62;Bladder-D-ICRU(Gy):3.00±0.36;Rectom-DLeadwire(Gy):2.00±0.38。2.CT-ICBT计划膀胱、直肠ICRU剂量和直肠铅丝剂量。Rectom-DICRU(Gy):3.93±0.88;Bladder-DICRU(Gy):4.32±0.78;Rectom-D Lead wire(Gy):2.53±0.38。3.CT-ICBT 三维计划(HR-CTV D90>500cGy)和二维计划(A 点 500cGy)危及器官剂量学和膀胱和直肠总剂量差异(A点累积剂量45-50Gy)。①D0.1cc(Gy):直肠 3D-Plan:4.11 ±0.65;2D-Plan:3.45±0.58(P=0.001)。膀胱 3D-Plan:3.94 ± 0.74;2D-Plan:2.79 ± 0.55(P=0.001)。Dlcc(Gy):直肠 3D-Plan:3.46±0.38;2D-Plan:2.70±0.37(P=0.000)。膀胱 3D-Plan:3.27 ± 0.42;2D-Plan:2.42 ± 0.38(P=0.001)。D2cc(Gy):直肠 3D-Plan:3.16±0.66;2D-Plan:2.44±0.44(P=0.000)。膀胱 3D-Plan:3.03 ± 0.51;2D-Plan:2.27 ±0.45(P=0.001)。②A 点累积剂量 45-50Gy 时直肠(Gy):3D-Plan:26.50±4.24;2D-Plan:31.40±6.20(P=0.003)。膀胱 3D-Plan:26.72±3.64;2D-Plan:30.0±3.60(P=0.003)。CT-ICBT 三维计划(HR-CTV D90>500cGy)膀胱和直肠 D0.1cc、D1cc 和 D2cc剂量均高于二维计划(A点500cGy),差异有统计学意义,但当A点累计剂量为4500-5000cGy时,CT-ICBT三维计划膀胱和直肠总剂量低于二维计划,差异有统计学意义。[研究结论]1.CT-ICBT 三维计划(HR-CTVD90>500cGy)膀胱和直肠 D0.1cc、D1cc 和 D2cc剂量均高于二维计划(A点500cGy),差异有统计学意义。2.当A点累计剂量为4500-5000cGy时,CT-ICBT三维计划膀胱和直肠总剂量低于二维计划,差异有统计学意义。第三部分 HT+CT-ICBT组和IMRT+ ICBT组患者近期不良反应、远期不良反应和近期疗效分析[摘要][研究目的]比较HT+CT-ICBT组和IMRT+ ICBT组患者近期不良反应、远期不良反应和近期疗效[研究方法]回顾性分析我院2014年(1月-12月)治疗的局部晚期(ⅡB-ⅢB)子宫颈癌患者,共47例,治疗方式均为同步放化疗。化疗方式为:紫杉醇+顺铂三周方案。根据体外放射和腔内放射治疗方式不同,分为HT+CT-ICBT组22例;IMRT+ICBT组25例。比较HT+CT-ICBT和IMRT+ ICBT两组患者近期不良反应、远期不良反应和3年无进展生存率(progression-free survival,PFS)和总生存率(Overallsurvival,OS)差异。[研究结果]1.近期不良反应:HT+CT-ICB组3-4级别急性血液系统反应发生率3/19(13.6%);IMRT+ ICBT组3-4级别急性血液系统反应发生率4/25(16%)。HT+CT-ICB组3-4级别急性消化道反应发生率2/22(9%);IMRT+ICBT组3-4级别急性消化道反应反应发生率5/25(16%)。HT+CT-ICB组3-4级别急性泌尿系统反应发生率2/22(9%);IMRT+ ICBT组3-4级别急性泌尿系统反应发生率4/25(16%)。HT+CT-ICB组3-4级别急性皮肤反应发生率2/22(9%);IMRT+ ICBT组3-4级别急性皮肤反应反应发生率3/25(12%)。HT+CT-ICB组和IMRT+ ICBT组比较均无统计学意义。P值分别为1.000、0.423、0.670和1.000。2.远期不良反应:HT+CT-ICB组3-4级别慢性放射性直肠炎发生率1/22(4.5%);IMRT+ ICBT组3-4级别慢性放射性直肠炎发生率7/25(28%)。HT+CT-ICB组3-4级别慢性放射性膀胱炎发生率0/22(0%);IMRT+ICBT组3-4级别慢性放射性膀胱炎反应发生率4/25(16%)。HT+CT-ICB组和IMRT+ICBT组比较均有统计学意义。P值分别为0.033、0.050。3.三年PFS和OS。随访截至2017年01月,两组患者共47例均完成随访,中位随访时间25月(12-36),无失访患者,随访率为100%。HT+CT-ICBT组患者中位随访时间26.5月(12-35),IMRT+ICBT组患者中位随访时间24(14-36)。HT+CT-ICBT 组患者 3 年 PFS 为 84.7%;IMRT+ICBT 组患者 3 年 PFS 为 77.4%,两组比较差异无显著性意义(P = 0.782)。HT+CT-ICBT组患者3年OS为86.5%;,IMRT+ICBT组患者3年OS为78.3%,两组比较差异无显著性意义(P = 0.596)。[研究结论]1.HT+CT-ICBT组远期放射性直肠炎和膀胱炎发生率低于IMRT+ ICBT组。2.HT+CT-ICBT 组和 IMRT+ ICBT 组 3 年 PFS 和 3 年 OS 无差异。更多还原

【Abstract】 [Background]Cervical cancer is one of the most common malignancies in gynecology,and is the second leading female malignancy after breast cancer.At present,China has about 10 million new cases of cervical cancer every year,and the trend of young age.National Comprehensive Cancer Network(NCCN)guidelines recommend concurrent chemoradiotherapy as the standard treatment for locally advanced cervical cancer.The radiation therapy consists of external beam irradiation and intracavitary brachytherapy.Severe toxicity is reported in approximately 35-40%of patients with conventional radiotherapy.With the progress of imaging and computer technology,new radiation modalities like three dimensional-conformal radiation therapy(3D-CRT)and intensity-modulated radiation therapy(IMRT)have been applied to cervical cancer.IMRT provides excellent coverage of PTV whereas significantly reducing doses to the organs at risk(OAR)like small bowel,rectum,and bladder.As a novel method of IMRT,helical tomotherapy(HT),which combines helical computed tomography(CT)with megavoltage linear accelerator,delivers dose distributions in a helical pattern,and the megavoltage CT allows for setup verification.HT attains more conformal PTV coverage than IMRT,and reduces the dose of OAR.Intracavitary brachytherapy is an indispensable treatment for cervical cancer.Conventional brachytherapy is two-dimensional radiography.The limitations of two dimensional intracavitary brachytherapy includes:unable to adjust plan with the changing size or shape of tumor,unable to accurately assess the dose of the bladder and rectum,which leads to inadequate target coverage and insuffcient dose delivery.CT or MRI based three dimensional intracavitary brachytherapy has been used in the treatment of cervical cancer since 2000.CT-ICBT and HT have been used in the treatment of cervical cancer in our hospital since 2012 and 2014 respectively.The purpose of this study was to evaluate the toxicity and clinical outcome in patients with locally advanced cervical cancer treated with HT+CT-ICBT by analyzing dosimetry and clinical data retrospectively.Part I Dosimetry study of PTV and OAR between HT and IMRT[ABSTRACT][Objective]To investigate the difference of PTV and OAR between HT and IMRT.[Method]47 patients with FIGOⅡB-ⅢB cervical cancer between January and December 2014 received concurrent chemoradiotherapy,dosimetry and clinical data were analyzed retrospectively.All patients received paclitaxel+cisplatin three weekly as the chemotherapy.22 patients were treated with HT+CT-ICBT,25 patients were treated with IMRT+ICBT.All patients underwent reduced field external beam radiation as follows:2880cGy delivered to the whole pelvic in 16 fractions,then the irradiated volume was reduced to lymphatic drainage region and parametrium for an additional 2160cGy boost in 12 fractions.Target volumes and OAR were delineated according to the recommendations of RTOG(Int.J.Radiation Oncology Biol.Phys.2010).Both the PTV and the OAR were analysed by DVH and isodose curves.To compare the dosimetric parameters of PTV and OAR for whole pelvis radiotherapy between HT and IMRT(2880cGy).To compare the dosimetric parameters of PTV and OAR for reduced field pelvis radiotherapy between HT and IMRT(2160cGy).To compare the dosimetric parameters of OAR for fusing whole pelvis radiotherapy plan and reduced field pelvis radiotherapy plan between HT and IMRT.[Results]1.Whole pelvis radiotherapy(2880cGy)①Isodose curves between HT and IMRT:The mean dose of PTV(Dmean)(Gy)of HT was 29.72±4.02,which was similar with IMRT(30.31±3.63.P=0.599).The volume of PTV receiving 105%of the prescription dose for HT was 9.80±2.26,which was similar with IMRT(10.31±2.06,P=0.422).PTV110%was zero both for HT and IMRT.The dose conformity(CI)was obviously improved with HT over IMRT(0.787±0.216 vs 0.656±0.221,P=0.046).The dose homogeneity(HI)for HT was 1.069±0.198,which was similar with IMRT(1.085±0.176;P=0.770).②Dosimetric parameters of OAR:The V40(%)of rectom,bladder,and bowel were obviously improved with HT over IMRT respectively(42.33±7.20 vs 49.68 ±7.94,P=0.001;33.91±6.82 vs 39.23±8.01,P=0.001;6.05±1.56 vs 7.19±2.02,P=0.037).But there were no significant difference in R-Femoral head and L-Femoral head between HT and IMRT(2.56±0.56 vs 2.93±0.52,P=0.721;3.01±0.68 vs 3.31±0.59,P=0.112).The mean dose of(Dmean)rectom,bladder,and bowel were obviously improved with HT over IMRT respectively(20.29±3.40 vs 23.07±4.85,P=0.029;17.95±5.34 vs 20.99±4.92,P=0.048;13.74±3.02 vs 15.55±2.91,P=0.042).No significant difference were found in R-Femoral head and L-Femoral head between HT and IMRT(12.27±3.06 vs 12.84±3.85,P=0.580;11.89±3.21 vs 12.92±1.45,P=0.154).2.Reduced field pelvis radiotherapy(2160cGy)①Isodose curves between RF-HT and RF-IMRT:The mean dose of PTV(Dmean)(Gy)of RF-HT was 22.25±5.12,which was similar with RF-IMRT(22.73±3.41.P=0.703).Both PTV105%and PTV110%was zero both for RF-HT and RF-IMRT.The dose conformity(CI)was obviously improved with RF-HT over RF-IMRT(0.800±0.202 vs 0.660±0.254,P=0.044).The dose homogeneity(HI)for RF-HT was 1.049±10.230,which was similar with RF-IMRT(1.051±0.147;P=0.972).②Dosimetric parameters of OAR:The V40(%)of rectom and bladder were obviously improved with RF-HT over RF-IMRT respectively(5.68 ± 0.48 vs 9.600±1.53,P=0.000;20.54±4.92 vs 26.68±3.46,P=0.000).But there were no significant difference in bowel,R-Femoral head and L-Femoral head between RF-HT and RF-IMRT(;5.97±0.44 vs 6.17±1.17,P=0.454;3.03±0.36vs 2.92±0.18,P=0.184;3.18±0.30vs 2.84±0.56,P=0.062).The mean dose of(Dmean)rectom and bladder were obviously improved with RF-HT over RF-IMRT respectively(11.57±2.22 vs 13.09±1.98,P=0.016;12.87±2.58 vs 14.66±3.02,P=0.035).No significant difference were found in bowel,R-Femoral head and L-Femoral head between RF-HT and RF-IMRT(10.48±1.53 vs 10.91±2.66,P=0.508;8.40±1.76 vs 8.10±2.26,P=0.0.617;8.49±1.02 vs 7.91±1.20,P=0.083).3.The Dmean(Gy)of OAR for fusing whole pelvis radiotherapy plan(2880cGy)and reduced field pelvis radiotherapy plan(2160cGy)between HT and IMRT.The mean dose of(Dmean)rectom,bladder,and bowel after PTV fusion were obviously improved with HT over IMRT respectively(32.06 ± 6.82 vs 35.39 ± 3.97,P=0.043;30.14± 7.97 vs 34.17±4.86,P=0.039;24.20±3.60 vs 25.47±3.90,P=0.254).No significant difference were found in R-Femoral head and L-Femoral head(20.38±2.22 vs 21.24±3.45,P=0.304;19.60±3.61 vs 22.41± 3.09,P=0.070).[Conclusion]1.The PTV coverage of HT plan was similar with IMRT plan.HT plan was significantly favored with regard to target conformity than IMRT plan.2.The V40(%)and Dmean of rectom,bladder,and bowel were obviously improved with HT over IMRT.Part II Dosimetry study of OAR between CT-ICBT and ICBT[ABSTRACT][Objective]To investigate the difference of OAR between CT-ICBT and ICBT[Method]47 patients with FIGO ⅡB-ⅢB cervical cancer between January and December 2014 received concurrent chemoradiotherapy,dosimetry and clinical data were analyzed retrospectively.All patients received paclitaxel+cisplatin three weekly as the chemotherapy.22 patients were treated with CT-ICBT.25 patients were treated with ICBT.To describe the isodose curves,Rectom-DLeed wire,Rectom-DICRU and Bladder-DICRU of ICBT.To describe the isodose curves,Rectom-DLead wire,Rectom-DICRu and Bladder-DICRU of CT-ICBT.To compare the isodose curves,OAR,rectom total dose,and bladder total dose between 3D-plan and 2D-plan for CT-ICBT.[Results]1.The isodose curves,Rectom-D Lead wire,Rectom-DICRU and Bladder-DICRU of ICBT.Rectom-DICRU(Gy):3.14±0.62;Bladder-DICRU(Gy):3.000±0.36;Rectom-D Lead wire(Gy):2.00±0.38.2.The isodose curves,Rectom,DLead wire,Rectom-DICRU and Bladder-DICRu of CT-ICBT.Rectom-DICRU(Gy):3.93±0.88;Bladder-DICRU(Gy):4.32±0.78;Rectom-D Lead wire(Gy):2.53 ± 0.38.3.The isodose curves,OAR,rectom total dose,and bladder total dose between 3D-plan and 2D-plan for CT-ICBT.①D0.1cc(Gy):The dose of rectom and bladder were significantly higher in 3D-Plan than that in 2D-Plan respectively(4.11±0.65 vs 3.45±0.58,P=0.001;3.94 ± 0.74 vs 2.79 ± 0.55,P=0.001).D1cc(Gy):The dose of rectom and bladder were significantly higher in 3D-Plan than that in 2D-Plan respectively(3.46±0.38 vs 2.70±0.37,P=0.000;3.27 ± 0.42 vs 2.42 ± 0.38,P=0.001).D2cc(Gy):The dose of rectom and bladder were significantly higher in 3D-Plan than that in 2D-Plan respectively(3.16±0.66 vs 2.44±0.44,P=0.000;3.03 ±0.51 vs 2.27 ±0.45,P=0.001).②When the dose of point A reached 45-50Gy,the dose of rectom and bladder were significantly decreased in 3D-Plan than that in 2D-Plan respectively(26.500±4.24 vs 31.40±6.20,P=0.003;26.72±3.64 vs 30.013.60,P=0.003).[Conclusion]1.The dose of rectom and bladder were significantly higher in 3D-Plan than that in 2D-Plan.2.The dose of rectom and bladder were significantly decreased in CT-ICBT than that in ICBT,when the total dose of point A reached 45-50Gy.Part Ⅲ Clinicle study of HT+CT-ICBT and IMRT+ICBT in treatment of locally advanced cervical cancer[ABSTRACT][Objective]To investigate the difference of toxicity and survival between HT+CT-ICBT and IMRT+ICBT.[Method]47 patients with FIGOⅡB-ⅢB cervical cancer between January and December 2014 received concurrent chemoradiotherapy,dosimetry and clinical data were analyzed retrospectively.All patients received paclitaxel+cisplatin three weekly as the chemotherapy.22 patients were treated with CT-ICBT.To compare acute toxicity,chronic toxicities,progression-free survival(PFS)and overall survival(OS)between HT+CT-ICBT group and IMRT+ ICBT group.[Results]1.Acute toxicity:No significant difference were found in hematologic,gastrointestinal,genitourinary,and cutaneous between HT+CT-ICBT and IMRT+ICBT.(P=1.000;P=0.423,P=0.670 P=1.000).2.Chronic toxicities:Proctitis and cystitis were significantly decreased in HT+CT-ICBT than that in IMRT+ ICBT respectively(P=0.033;P=0.050).3.PFS and OS:The 3 years PFS was 84.7%in HT+CT-ICBT,which was similar with IMRT+ ICBT(84.7%VS 77.4%,P = 0.782).The 3 years OS was 84.7%in HT+CT-ICBT,which was similar with IMRT+ ICBT(86.5%VS 78.3%,P = 0.596).[Conclusion]1.Chronic proctitis and cystitis were significantly decreased in HT+CT-ICBT group than that in IMRT+ 1CBT group.2.The 3 years PFS and OS in HT+CT-ICBT group were similar with IMRT+ ICBT group.更多还原