目的:探讨妇科肿瘤患者调强放疗(IMRT)俯卧位与急性放射性肠炎剂量学差异。
方法:对2020年1月至2021年7月接受IMRT的妇科肿瘤患者进行分析。60例患者根据放疗体位不同分为仰卧位或俯卧位组,其中俯卧位34例,仰卧位26例。比较两组患者的高危器官(OARs)剂量-体积直方图及急性放射性肠炎发生率。多因素logistic回归分析显示急性放射性肠炎的临床特征和剂量体积指标与急性放射性肠炎的相关性。
结果:接收5Gy的体积百分比,10Gy,15Gy,20Gy,30Gy,40Gy,小肠45Gy剂量为79.0%,67.4%,59.6%,44.3%,17.0%,8.9%,和6.0%,分别在易感组中,低于仰卧组(P<0.05)。俯卧组小肠暴露的平均辐射剂量(Dmean)降低(P<0.001)。与仰卧组相比,易发的急性放射性肠炎患者较少。消化不良的可能性,恶心,呕吐,腹泻,俯卧位腹痛占35.29%,29.41%,17.65%,38.24%,5.88%,分别。消化不良的差异,恶心,两组间腹泻差异有统计学意义(P=0.012,P=0.029,P=0.041)。多因素logistic回归分析显示俯卧位对消化不良有保护作用(P=0.002),恶心(P=0.013),呕吐(P=0.035),腹痛(P=0.021)。
结论:在妇科肿瘤的IMRT中俯卧位可以显著降低对小肠和结肠的辐射剂量,这可能会降低急性肠道副作用的发生和严重程度。
OBJECTIVE: To probe the differences of dosimetry and acute radiation enteritis between prone and supine position in gynecological cancer patients treated with intensity-modulate radiotherapy (IMRT).
METHODS: Gynecologic tumor patients who received IMRT from January 2020 to July 2021 were analyzed. 60 patients were enrolled and divided into the supine or prone position group according to different radiotherapy positions, including 34 patients in prone position and 26 patients in supine position. The dose-volume histogram of organs at risk (OARs) and the incidence of acute radiation enteritis were compared between the two groups. Multivariate logistic regression analysis was conducted to show the clinical characteristics and dose volume metrics to the association of acute radiation enteritis.
RESULTS: The percentage of volume receiving 5 Gy, 10 Gy, 15 Gy, 20 Gy, 30 Gy, 40 Gy, and 45 Gy doses for the small intestine were 79.0%, 67.4%, 59.6%, 44.3%, 17.0%, 8.9%, and 6.0%, respectively in the prone group, which were lower than those in the supine group (P < 0.05). The mean radiation dose (Dmean ) of the small intestine exposure in prone group was decreased (P < 0.001). Compared with the supine group, the prone group who suffered from acute radiation enteritis were much less. The probability of indigestion, nausea, vomiting, diarrhea, and abdominal pain in the prone position were 35.29%, 29.41%, 17.65%, 38.24%, and 5.88%, respectively. The differences in indigestion, nausea, and diarrhea between the two groups were statistically significant (P = 0.012, P = 0.029, and P = 0.041). Multivariate logistic regression analysis was shown that prone position was found to be protective against indigestion (P = 0.002), nausea (P = 0.013), vomiting (P = 0.035), and abdominal pain (P = 0.021).
CONCLUSIONS: Prone position in IMRT for gynecological cancers could significantly reduce radiation dose to the small bowel and colon, which would decrease the occurrence and severity of acute intestinal side effects possibly.