| Objective:Seminoma is a highly malignant tumor originating from the primordial germ cells of the testis,mostly occurring in the testis,occasionally in the mediastinum,retroperitoneum,pineal gland,etc.Spermatoblastoma is more common in middle-aged men.Surgery is the preferred treatment for testicular seminoma supplemented by radiotherapy or chemotherapy postoperatively according to pathological diagnosis and the cure rate is over 90%.Because testicular seminoma is highly sensitive to radiotherapy,postoperative adjuvant radiotherapy can reduce its local recurrence rateMore over,the 5-year over survival rate of early testicular seminoma is over90%.Postoperative adjuvant radiotherapy has become the main treatment for early testicular seminoma.Since the prognosis of testicular seminoma is good,it is the focus to reduce the adverse effects of adjuvant treatment and improvelife quality of patients.With the development of science and technology,radiotherapy began to enter the era of precision therapy.Whether precision radiotherapy can be achieved is closely related to radiotherapy technology.Helical tomography is one of the techniques of intensity-modulated radiotherapy(IMRT),which is the main radiotherapy technique,based on three-dimensional conformal radiotherapy,to achieve the uniform of dose distribution in targeted area through computer retrograde operation.Compare to conventionalIMRT,helical tomography provides high homogeneity and conformability of the dose distribution in targeted area through image guiding,adaptive function and dose-guided functions,to avoide adjacent normal tissues and organs properly,reduce the incidence of adverse reactions,and radioactive damage,finally to achieve precise radiotherapy and individualized treatment.In this study,we compared the dosimetric distribution of helical tomography and conventional IMRT in the early stage of testicular seminoma,and analyzed their adverse reactions and short-term efficacy.Part one Dosimetric distribution of tomography and intensity-modulated radiotherapy for stage IIA / IIB testicular seminoma Objective:To compare the difference of dose distribution between tomography(TOMO)and intensity-modulated radiotherapy(IMRT)in the treatment of stage IIA / IIB testicular seminoma.Methods:A total of 15 patients with IIA/IIB seminoma who underwent postoperative adjuvant radiotherapy in the First Affiliated Hospital of Zhengzhou University from 2015 to 2018 were enrolled.Both TOMO and IMRT plans were designed for these patients.The following indexes of two radiotherapy plans were compared: conformity(CI),uniformity index(HI),and dose on organ at risk(OAR),including maximum dose(Dmax)and mean dose(Dmean)of testes,small intestine,liver,femoral head,kidney,etc.,and systemic Dmean and spinal cord Dmax.Results:There was no significant difference of V30.6 between TOMO and IMRT(P > 0.05).CI was higher inTOMO than in IMRT.And HI was lower in TOMO than in IMRT,and the differences were statistically significant(P < 0.05).The Dmax and Dmean of testis,Dmax of small intestine and Dmean of liver were lower in TOMO than in IMRT,and the differences were statistically significant(all P < 0.05).There were no significant differences in the Dmean of total body,Dmax and Dmean of femoral head,Dmax of liver,Dmax and Dmean of kidney,Dmax of spinal cord between TOMO and IMRT(P < 0.05).Conclusions:For patients with testicular seminoma,both TOMO and IMRT can meet the prescribed dose requirements,And there is no significant difference in the whole body average irradiation dose between the two radiotherapy techniques.But the target area conformability and homogeneity of TOMO are better than that of IMRT without compromise on dose.TOMO could’t make the testicular,liver,small intestine and other important OAR exposeure to dangerous dose.Part two Comparison of adverse reactions and short-term effects of tomography in postoperative radiotherapy for early testicular seminomaObjective:To analyze the adverse reactions and short-term effects of tomography(TOMO)in postoperative radiotherapy for early testicular seminoma.Methods:Retrospective analysis of 42 patients with pathological diagnosis of testicular seminoma in the Department of Radiation Oncology,First Affiliated Hospital of Zhengzhou University from August 2015 to February 2019.All patients were pathologically diagnosed as seminoma.including 21 patients in the TOMO treatment group and 21 patients in the IMRT treatment group.The doses of radiotherapy were 30-36 Gy.The chest and abdomen enhanced CT,neck and abdomen color ultrasound,and tumor marker(mainly alpha-fetoprotein,lactate dehydrogenase,human chorionic gonadotropin,etc.)were performed every four weeks to evaluate the efficacy.The effectiveness,disease control rate,and incidence of adverse reactions were compared between the two groups.Results:1.All 42 patients enrolled in the group completed radiotherapy plans.In TOMO group,13 cases achieve complete remission(CR),3 cases achieve partial remission(PR),5 cases achieve stable(SD),no patients have disease progression,effective rate(RR)was 76.2%,disease control rate was 100%.In IMRT Group: 12 cases achieve complete remission(CR),3 cases achieve partial remission(PR),6 cases achieve stable(SD),no patients have disease progression,effective rate(RR)71.4%,disease control rate 100%.There was no significant difference in RR between TOMO group and IMRT group(χ2=0.123,P>0.05).The disease control rate of both groups was 100%.2.The adverse reactions in the two groups were mainly hematologic toxicity,acute gastrointestinal reactions and acute radiation enteritis.The adverse reactions were mainly grade 1 to 2.The incidence of hematological toxicity was not statistically significant between the two groups(P> 0.05).The incidence of gastrointestinal tract in the TOMO group was lower than in the IMRT group,and the difference was statistically significant(P<0.05).Conclusions:The short-term efficacy are comparable between TOMO and IMRT in postoperative radiotherapy for early testicular seminoma,but TOMO has a lower incidence of acute gastrointestinal adverse events.Therefore,TOMO can be used as a preferred treatment for postoperative radiotherapy in patients with testicular testicular seminoma... |
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