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目的:比较子宫内膜癌患者行调强放疗（IMRT）与三维适形放疗（3DCRT）的疗效，并分析影响预后的因素。方法:回顾性分析2015年1月至2017年12月浙江省肿瘤医院258例行全盆腔放疗的Ⅰ～ⅢC期子宫内膜癌患者的临床资料。其中，采用3DCRT 128例（3DCRT组），IMRT 130例（IMRT组）。宫颈浸润患者再给予低剂量率阴道近距离放疗。观察局部复发、无病生存（DFS）和总生存（OS）及不良反应；并对相关因素进行统计分析。结果:258例患者随访6～34（28.6 ± 1.2）个月，18例发生局部复发，3DCRT组15例，IMRT组3例。3DCRT组和IMRT组局部控制率分别为86.0%（95% n CI 74.5～92.4）和94.2%（95% n CI 92.8～100.0），两组比较差异无统计学意义（n P>0.05）。36例患者发生远处转移，3DCRT组远处转移率明显高于IMRT组［19.5% （25/128）比8.5%（11/130）］，差异有统计学意义（n P0.05）。Cox单因素分析结果显示，年龄>68岁、恶性程度3级、未行淋巴结切除和> Tn 1期与肿瘤远处转移有关（n P Tn 1期和恶性程度3级是子宫内膜癌患者发生远处转移的独立危险因素（n HR = 4.0、3.3和2.1，95% n CI 1.5～9.7、1.5～7.4和1.2～3.5，n P0.05）。3DCRT组和IMRT组2年OS率分别为91.6%（95%n CI 68.9～95.8）和95.5%（95% n CI 65.8～98.6），两组比较差异无统计学意义（n P>0.05）。IMRT组≥ 2级急性胃肠道不良反应和2级急性泌尿生殖道不良反应发生率明显低于3DCRT组［20.0%（26/130）比32.8%（42/128）和2.3%（3/130）比10.9% （14/128）］，差异有统计学意义（n P0.05). Thirty-six patients had distant metastasis. The distant metastasis rate in 3DCRT group was significantly higher than that in IMRT group: 19.5% (25/128) vs. 8.5% (11/130), and there was statistical difference (n P0.05). Cox univariate analysis result showed that age > 68 years, grade 3 malignancy, no lymphadenectomy and > Tn 1 stage were related to distant tumor metastasis (n P Tn 1 stage and grade 3 malignancy were independent risk factors for distant metastasis in patients with endometrial cancer (n HR = 4.0, 3.3 and 2.1; 95% n CI 1.5 to 9.7, 1.5 to 7.4 and 1.2 to 3.5; n P0.05). The 2-year OS rates in 3DCRT group and IMRT group were 91.6% (95%n CI 68.9 to 95.8) and 95.5% (95% n CI 65.8 to 98.6), and there was no statistical difference between 2 groups (n P>0.05). The incidences of ≥ 2 grade acute gastrointestinal adverse reactions and grade 2 acute urogenital tract adverse reactions in IMRT group were significantly lower than that in 3DCRT group: 20.0% (26/130) vs. 32.8% (42/128) and 2.3% (3/130) vs. 10.9% (14/128), and there were statistical differences (n P<0.05). One patient in 3DCRT group had late gastrointestinal adverse reaction (grade 3 radiation enteritis).n Conclusions:Compared with 3DCRT, IMRT is a safer method for treating patients after endometrial cancer surgery, and the risks of acute gastrointestinal and urogenital tract adverse reactions are lower.