| Background: Cervical cancer is one of the most common diseases in women with malignant tumors worldwide.Cervical cancer can be cured by surgery,radiotherapy and chemotherapy.Radiotherapy is one of the main treatments for cervical cancer,about 70%~80% of cervical cancer patients need radiotherapy and it can reduce the distant metastasis rate of the tumor,improve the survival rate and local control rate of the patient,but increase the adverse reaction accordingly.IMRT is a radiotherapy technique widely used in gynecological tumors in recent years.It can further improve the therapeutic effect of cervical cancer,and at the same time reduce the dose of peripherally endangered organs.Helical tomotherapy is an image-mediated,highly conformal,three-dimensional intensity-modulated radiotherapy technique that combines treatment planning,patient placement,and treatment to simplify the treatment process and obtain mega-level images from each treatment.The tumor dose distribution and the tumor change during the treatment can be observed through the mega-volt image obtained by each treatment,the treatment plan of the target volume can be adjusted in time,and the probability of off-target can be reduced.The advantages of total pelvic helical tomotherapy were investigated by comparing data on HT and IMRT after cervical cancer surgery.Purpose: We compared the acute and chronic toxicity,short-term efficacy and endangered organs caused by IMRT in patients with early cervical cancer after operation with helical tomotherapy and intensity-modulated radiation in this study,and explored whether there is an advantage in total pelvic helical tomography after cervical cancer surgery.Methods: Retrospective analysis of 176 patients with early-stage cervical cancer in our hospital with high-risk factors.All patients underwent adjuvant radiotherapy combined with chemotherapy according to adjuvant therapy.According to radiotherapy technology,it wasdivided into helical tomography group(96 cases in HT group)and intensity-modulated radiotherapy group(80 cases in IMRT group).The evaluation of acute and chronic side effects of the blood system,digestive system,and genitourinary system during radiotherapy in all groups of patients.The 1~3 year survival rate of all patients in the two groups was compared.The dose parameters of organs such as rectum,bladder,and femoral head were compared in10 patients in each group.Results: 1).In terms of dose: The conformal index CI of the radiotherapy target of HT and IMRT in spiral tomography was 0.880±0.025 and 0.756±0.009,respectively,with significant difference(P = 0.001),and the uniformity index HI of HT and IMRT was1.083±0.003 and 1.106 ± 0.005,with a significant difference(P = 0.000).The Dmax of HT and IMRT were 55.43±0.551 and 56.36±0.161,respectively,with statistical significance(P =0.004).For the V30 and V40 of the rectum,the volume of the HT group was significantly lower than that of the IMRT group(P = 0.003,P = 0.002).For the V40 and V45 of the bladder,the volume of the HT group was significantly lower than that of the IMRT group(P = 0.007,P = 0.005).HT has a dosimetric advantage in the rectal V45,Dmax,Dmean and bladder Dmax,Dmean,but there is no significant difference in statistics.Helical tomography was significantly lower than that of IMRT in V5,Dmin,Dmax and Dmean of bilateral ovaries,with significant advantages(P < 0.05).The volume of V20,V30,and V40 in the bilateral femoral head decreased by helical tomography.The dose of HT was higher than that of IMRT on Dmax and Dmean.There was no significant difference between the two groups.2)Adverse reactions: The incidence of I~IV myelosuppression in leukocytes in the HT group and the IMRT group during the treatment period was 9.38%,30.20%,45.83%,4.17%,and 10%,45%,32.5 %,and 8.75%,respectively.The incidence of I~IV myelosuppression in hemoglobin was43.75%,16.67%,3.12%,0% and 38.75%,26.25%,6.25%,2.5%,respectively.The incidence of platelet I~IV myelosuppression was 14.58%,19.79%,1.04%,1.04%,and 26.25%,15%,3.75%,and 0%,respectively.There was a significant difference in the degree of hemoglobin myelosuppression between the two groups(P = 0.003).There was no significant difference between the two groups in leukocyte myelosuppression(P = 0.315)and platelet myelosuppression(P = 0.333).In this study,8 patients(8.33%)and 12 patients(15%)in the HT group and the IMRT group had grade 3 or higher acute gastrointestinal reactions,and thedifference was not statistically significant(P = 0.165).9 patients(9.38%)and 10 patients(12.5%)had acute urinary systemic response in the HT group and the IMRT group,respectively,and the difference was not statistically significant(P = 0.506).In the long-term follow-up,2 patients(2.08%)and 4 patients(5.00%)had chronic cystitis reaction of grade 3or higher in the HT group and the IMRT group,respectively,and there was no statistical significance(P = 0.519).There were 1 case(1.04%)and 2 cases(2.50%)between the HT group and the IMRT group with grade 3 and above advanced chronic proctitis reaction(P =0.873),no statistical difference.3)Prognosis: The 1-year,2-year,and 3-year survival rates of the HT and IMRT groups were 95.6%,91.6%,91.6%,and 98.8%,92.0%,and 89.0%,respectively,and the difference was not statistically significant(P = 0.797).The three-year progression-free survival rate was 92.5%,and the IMRT group was 73.3%,The difference was not statistically significant(P = 0.079).Conclusion: Helical tomography radiotherapy has better target area conformity and dose uniformity than IMRT.The dose of the dangerous organs in the bladder,femoral head and rectum is lower than IMRT,which reduces the incidence of side effects and improves the prognosis of patients.Helical tomography has a protective effect on organs and is a good choice. |
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