摘要目的 分析比较调强放疗(IMRT)和三维适形放疗(3D-CRT)治疗局部晚期直肠癌的近远期效果与安全性.方法 回顾性分析2013年8月至2015年8月安阳市肿瘤医院收治的118例局部晚期直肠癌患者的临床资料,根据其术后治疗方式分为IMRT组(IMRT+化疗)与3D-CRT组(3D-CRT+化疗),每组59例.比较两组靶区剂量学指标、近期疗效、不良反应与远期疗效.结果 两组计划靶区放疗剂量(PTV95％)均为100％,达到处方剂量要求,IMRT组PTV100％、PTV边界剂量低于3D-CRT组(P<0.05),PTV105％高于3D-CRT组(P<0.05),且靶区剂量均匀度指数(HI)比3D-CRT组更接近于1(P<0.05);放化疗结束后,IMRT组与3D-CRT组近期临床总有效率比较差异未见统计学意义(P>0.05);放疗结束后,两组不良反应发生情况比较差异未见统计学意义(P>0.05);术后1、2、3年,两组局部复发率与总生存率比较差异均未见统计学意义(P均>0.05).结论 IMRT与3D-CRT对局部晚期直肠癌近远期疗效与安全性相似,但IMRT靶区均匀性更佳.

abstractsObjective To compare and analyze the short-term and long-term effects and safety of intensity-modulated radiotherapy ( IMRT) and three-dimensional conformal radiotherapy (3D-CRT) in the treatment of locally advanced rectal cancer .Methods The clinical data of 118 patients with locally advanced rectal cancer admitted to Anyang Cancer Hospital from August 2013 to August 2015 were retrospectively analyzed .And patients were divided into IMRT group ( IMRT plus chemotherapy ) and 3D-CRT group (3D-CRT plus chemotherapy) according to the postoperative treatment methods , with 59 cases in each group.Dosimetric indicators in target volume , short-term efficacy, adverse reactions and long-term efficacy were compared between the two groups .Results The planning target volumes ( PTV) 95％of the two groups were 100％, reaching the prescription dose requirement .The PTV 100％ and PTV boundary dosage in IMRT group were significantly lower than those in 3 D-CRT group ( P<0.05 );and the PTV105％of IMRT group was significantly higher than that of 3D-CRT group ( P<0.05);while the homogeneity index (HI) value in IMRT group was more close to 1 than 3D-CRT group (P<0.05). There was no significant difference in total clinical short-term effective rate between IMRT group and 3 D-CRT group after radiotherapy and chemotherapy ( P>0.05 ) . After radiotherapy , there was no significant difference in the incidence of adverse reactions between the two groups ( P>0.05 ) .There was no difference in local recurrence rate or overall survival rate between the two groups at 1, 2, 3 years after treatment ( P>0.05 ) .Conclusions IMRT and 3 D-CRT have no significant difference in the short-term or long-term efficacy , and they have similar safety of locally advanced rectal cancer , but IMRT has better uniformity of target volume .