Intensity-modulated whole pelvic radiotherapy in women with gynecologic malignancies
Intensity-modulated whole pelvic radiotherapy in women with gynecologic malignancies
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DOI：
10.1016/s0360-3016(01)02785-7
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发表时间：
2002-04-01
影响因子：
7
通讯作者：
Roeske, JC
中科院分区：
文献类型：
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作者：
Mundt, AJ;Lujan, AE;Roeske, JC
目的：描述我们的初步临床经验与强度调制全盆腔放射治疗（IM- WPRT）的妇女与妇科malignances.Methods和材料：2000年2月至2001年8月，40例妇科患者接受IM-WPRT。在定制固定后，所有患者均接受对比增强CT，并勾画临床靶体积，包括上阴道、子宫旁组织、子宫（如果存在）以及骶前和盆腔淋巴结区域。将临床靶体积扩大1 cm以创建计划靶体积（PTV）。使用市售软件，为所有患者生成7或9场、6 MV、共面IM-WPRT计划。治疗期间最严重的急性胃肠道和泌尿生殖系统毒性采用4分量表评分：0，无; 1，轻度，不需要药物; 2，中度，需要药物; 3，重度，治疗中断或停止，住院。作为比较，分析了35例既往接受过常规WPRT治疗的患者的急性毒性。两组之间的临床病理和治疗因素无显着差异。结果：IM-WPRT计划提供了良好的PTV覆盖，与周围正常组织的相当大的保留。平均而言，98.1%的PTV接受了处方剂量。接受110%和115%处方剂量的PTV的平均百分比分别为9.8%和0.2%。IM-WPRT耐受性良好，没有患者发生3级毒性。IM-WPRT组2级急性胃肠道毒性发生率低于常规WPRT组（60%对91%，p = 0.002）。此外，IM-WPRT和WPRT患者不需要或只需要很少使用抗真菌药物的百分比分别为75%和34%（p = 0.001）。虽然IM-WPRT组的2级泌尿生殖系统毒性较低（10% vs. 20%），但差异无统计学意义（p = 0.22）。结论：IM-WPRT是妇科患者有前途的方法。调强放射治疗计划导致了良好的PTV覆盖，与正常组织的相当大的保留。治疗耐受性良好，与传统WPRT相比，急性胃肠道后遗症较少。然而，需要更长的随访时间和更多的患者来评估这种新方法的全部优点。(C)2002年爱思唯尔科技有限公司
Purpose: To describe our initial clinical experience with intensity-modulated whole pelvic radiotherapy (IM- WPRT) in women with gynecologic malignancies.Methods and Materials: Between February 2000 and August 2001, 40 gynecology patients underwent IM-WPRT. After fabrication of customized immobilization, all patients underwent contrast-enhanced CT, and a clinical target volume was contoured consisting of the upper vagina, parametria, uterus (if present), and presacral and pelvic lymph node regions. The clinical target volume was expanded by 1 cm to create a planning target volume (PTV). Using commercially available software, 7- or 9-field, 6-MV, coplanar IM-WPRT plans were generated for all patients. The worst acute gastrointestinal and genitourinary toxicity during treatment was scored on a 4-point scale: 0, none; 1, mild, no medications required; 2, moderate, medications required; and 3, severe, treatment breaks or cessation, hospitalization. As a comparison, acute toxicities in 35 previously treated conventional WPRT patients were analyzed. No significant differences were noted in the clinicopathologic and treatment factors between the two groups.Results: IM-WPRT plans provided excellent PTV coverage, with considerable sparing of the surrounding normal tissues. On average, 98.1% of the PTV received the prescription dose. The average percentage of the PTV receiving 110% and 115% of the prescription dose was 9.8% and 0.2%, respectively. IM-WPRT was well tolerated, with no patient developing Grade 3 toxicity. Grade 2 acute gastrointestinal toxicity was less common in the IM-WPRT group (60 vs. 91%,p = 0.002) than in the conventional WPRT group. Moreover, the percentage of IM-WPRT and WPRT patients requiring no or only infrequent antidiarrheal medications was 75% and 34%, respectively (p = 0.001). Although less Grade 2 genitourinary toxicity was seen in the IM-WPRT group (10% vs. 20%), this difference was not statistically significant (p = 0.22).Conclusion: IM-WPRT is a promising approach in gynecology patients. IMRT planning resulted in excellent PTV coverage, with considerable sparing of normal tissues. Treatment was well tolerated and associated with less acute gastrointestinal sequelae than conventional WPRT. Longer follow-up and more patients are needed, however, to evaluate the full merits of this novel approach. (C) 2002 Elsevier Science Inc.