目的 探讨对于巨块型子宫颈癌急性出血患者，探讨肿瘤中心前程同步加量放疗（SIB-IMRT）的有效性和安全性。方法 回顾性分析2019年1月至2023年1月在南京中医药大学附属医院放疗科施行SIB-IMRT治疗巨块型子宫颈癌出血患者的临床资料，采用倾向性评分匹配法对肿瘤中心前程同步加量放疗和常规调强放疗（IMRT）患者进行匹配，共20对40例患者纳入研究。前程同步加量（SIB）组首程（前3次）给予肿瘤中心（子宫颈肿块边缘内收1.5~2cm区域）15Gy/3f，肿瘤非中心区及淋巴引流区给予46Gy/23f。对照组患者全程使用常规分割调强放疗，子宫颈肿块及盆腔淋巴引流区46Gy/23f。两组外照射结束后均予近距离治疗。主要研究终点是止血效果，次要终点是副反应、局控率和总生存率。结果 中位随访时间为48个月。1周后SIB组和对照组的止血有效率分别是100%和40%。两组的急慢性毒副反应、局控率和总生存率差异吴统计学意义。结论 对于巨块型子宫颈癌出血患者，肿瘤中心前程同步加量放疗的安全性和有效性良好，可选择性应用于适宜患者。

Objective To evaluate the clinical efficacy and safety of simultaneously integrated boost-intensity modulated radiotherapy（SIB-IMRT） to the tumor center in the initial stage in patients with bulky cervical cancer with acute bleeding. Methods Retrospective analysis was performed on the clinical data of the patients with bulky cervical cancer with bleeding who received SIB-IMRT to the tumor center in the initial stage in the Radiotherapy Department of Affiliated Hospital of Nanjing University of Chinese Medicine from January 2019 to January 2023. The propensity score matching method was used to match patients receiving SIB-IMRT to the tumor center in the initial stage with those receiving conventional IMRT. A total of 20 pairs of 40 patients were included in the study. In the SIB group 15 Gy in 3 fractions was delivered to the tumor center （the region that was the subtractive margin from the tumor boundary by 1.5 to 2 cm）, and simultaneously 46 Gy in 23 fractions was delivered to the periphery of tumor and lymphatic drainage area of pelvic cavity at the initial three times of external irradiation. In the second course，the tumor and pelvic lymphatic drainage area were given a conventional fractionated dose of 40 Gy in 20 fractions. The patients treated with conventional IMRT （46 Gy/23 fractions）in cervical mass and pelvic lymphatic drainage area were regarded as control group. After the external irradiation, intracavitary radiotherapy was given. The primary endpoint was hemostasis effect. The secondary endpoints included adverse events（AEs），local contral（LC）rate and overall survival（OS）rate. Results Median follow-up was 48 months. The effective hemostasis rates in the SIB group and the control group in one week were 100% and 40%，respectively.There were no statistically significant differences in LC rate，OS rate，or acute and late AEs between two groups. Conclusion SIB-IMRT is effective and safe for bulky cervical cancer patients with bleeding, which can be selectively used in suitable patients.