| Background and Objective:Cervical cancer is the most common type of female tumor in China.In recent years,with the rapid development of radiation therapy technology,Intensity modulated radiotherapy and two-dimensional afterloading radiotherapy have been more widely used,gradually replacing the traditional two-dimensional conventional radiotherapy.Three-dimensional conformal radiation therapy(3-d CRT)has become the preferred method for the treatment of cervical cancer.However,the emergence of three-dimensional intracavitary post loading radiotherapy can improve the control rate of primary cervical tumor lesions,and at the same time,The dose and volume of the surrounding organs at risk can be reduced by more accurate regulation and detection of the dose distribution in the radiation target area and normal tissues.The study focused on by investigating conformal intensity modulated radiation therapy(IMRT)combined with two-dimensional and three-dimensional cavity after radiotherapy after loading and cisplatin(DDP)synchronous chemotherapy middle-late don’t cervical tumor dose and side effects,analyze endanger organs(including the small intestine,bladder and rectum dose assessment and monitoring of thrombocytopenia in patients with gastrointestinal tract reaction,radioactive cystitis and the reaction of radiation proctopathy,record Dmin,two groups of patients,on3 dmax Dmean,D2 cc dose distribution,analysis and assessment of the two kinds of treatment methods for the affected organs(bladder,small intestine,rectum)dose,2 cm3 irradiation dose(D2 cc)and clinical side effects.Then,the protective effect of IMRT combined with three-dimensional intracavitary post loading radiotherapy on the oar was analyzed.Materials and Methods: Choose west anhui medical university affiliated provincial medical from March 2015 to October 2017 between 86 cases of patients,and the examination of department of gynaecology,vaginal endoscopy and cervical live cut pathology verify diagnosed with locally advanced cervical squamous cell carcinoma(II ~ III B B)data of cases,after a decision to give strict clinical discussion on radiation therapy,this kind of locally advanced cervical cancer(according to the international association of obstetrics and gynecology doctors(FIGO)formulate guidelines)and not far.The patients were aged 34-69 years,with an average age of 49.72 11.07 years.According to different treatment methods,the patients were divided into the 2d posterior instrumentation group(47 cases)and the 3d intracavitary posterior instrumentation group(39 cases).All patients met the requirements of diagnostic criteria for advanced cervical cancer.Conventional imaging and cervical biopsy were diagnosed as stage IIB-IIIB without radiotherapy or chemotherapy.No distant metastasis was found on imaging examination,and the Karnofsky score was 70 on >.After communication,the patient and his family fully understood the situation and agreed to sign the informed consent of the patient.No rectal and bladder diseases(normal rectal function,no rectal abnormality in rectal examination by colonoscopy),routine physical examination,chest X-ray and b-ultrasound were observed before chemotherapy and radiotherapy.Heart,liver,kidney and other major organ diseases are not complicated,no tumor,uterus or fallopian tube ovarian pelvic surgery history.All mri images of the pelvis were collected before and after radiotherapy and chemotherapy.According to different treatment methods,47 patients in the posterior 2d internal fixation group received IMRT combined with 2d internal fixation radiotherapy.Thirty-nine patients received IMRT combined with three-dimensional intracavitary fixation radiotherapy and DDP combined with chemotherapy.All patients were treated with TPS,and the target area was regularly located and plotted.CTV includes high-risk areas of uterine tissue as well as vaginal,uterine and lymphatic drainage areas.Obturator and retroperitoneal lymphatic drainage areas;The vagina reaches the first third of the ligament.Phase IIIB includes the para-aortic lymphatic drainage area(PTV).Considering the positioning error,PTV was extended by 7mm on the basis of CTV.Using intensity modulation technology of 5~7 equal center points of the field,PTV design volume is 45.0~50.4Gy,1.8Gy/ time.25 to 28 times,5 times a week.36-41.4Gy / 20 ~ 23 times of 3d intracavitary and internal fixation group external irra diation,1 ~ 2 times/week of ct-guided stereoradiotherapy,a total of 5 ~ 7 times.In the 2d group,radiotherapy and external irradiation were 36 ~ 41.4 Gy / 20 ~23 times,and 2d intracavitary radiotherapy was 1 ~ 2 times a week,5 ~ 7 times.The dosages of the key affected organs(small intestine,bladder,and rectum),2cm3 exposure dose(D2 cc),and side effects were analyzed and evaluated between the two treatments.Results: The radiation dose Dmin,Dmax,Dmean and D2 cc of the organs at risk(small intestine,bladder and rectum)in the three-dimensional post-loading group were all lower than those in the two-dimensional post-loading group(P[0.05);platelet reduction(23.09%),gastrointestinal reaction(47.72%),radioactive cystitis(28/39),and radioactive proctitis(56.41%)in the three-dimensional post-loading group were significantly lower than those in the two-dimensional post-loading group(70.21%(33/47),65.96%(31/47),and 82.98%(39/4)7),80.85%(38/47)(both P(0.05).After 3 d group,endanger organ illuminated dosage is low.IMRT combined3 d cavity after radiation and DDP synchronous chemotherapy in the small inte stine,bladder and rectum the dose of protection is better than that of two-dimen sional cavity volume group.After the three-dimensional post-processing group can significantly reduce the gastrointestinal reaction and thrombocytopenia,ray utilization rate is higher,improve its clinical value.Conclusion:For locally advanced cervical cancer treated first,choose IMRT combined 3 d cavity after radiotherapy and DDP synchronous chemotherapy treatment not only can the dosimetry Angle can obviously reduce the illuminated dose of endanger organs,so as to achieve therapeutic effect on tumor,and in the rectum and bladder function protection and reduce the toxic effects have obvious advantages.Three-dimensional intracavitary retrograde radiotherapy can be used as the first choice for the treatment of advanced cervical cancer. |
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