HDR腔内超分割放射治疗宫颈癌临床研究  

Preliminary results of HDR brachytherapy of cervical carcinoma with twice daily

作　　者：张新忠[1] 吴畏[1] 宋宏羽[1] 李黎军[1] 潘洁森[1] 程媛[1] 郎锦义[2] 

机构地区：[1]南方医大附属深圳宝安医院放疗科,深圳518101 [2]四川省肿瘤医院放疗科,成都610041

出　　处：《中国实用医药》2007年第8期1-3,共3页China Practical Medicine

基　　金：深圳市科技局资助项目(2005231)

摘　　要：目的采用非常规的腔内治疗分割方式,探讨其方法的可行性与临床生物剂量效应。方法体外放疗(ExRT)+HDR腔内放疗(ICRT):65例病人:①Ⅱb全盆腔DT40Gy/4W/20F,Ⅲb46Gy/4·6W/23F;②结束后挡铅(中央遮挡铅块5HVL,4cm宽)B点DT补量(12～16)Gy/(6～8)F/(1·2～1·6)W;③Ⅱb、ⅢbA点3·3Gy/次,2次/d,两次间隔≥6h,每周间隔3d重复治疗,总计6次/3d/1·5W,A点总量DT1980cGy;④挡铅后ExRT与ICRT交替进行。结果结束时局部疗效CR52例(80%),PR13例(20%),NC0例,PD0例。1年生存率93·8%(61/65)。阴道反应Ⅰ度40例(62%),Ⅱ度19例(30%),Ⅲ度6例(8%),无1例因反应而导致治疗非计划中断。结论该方法可行,近期疗效满意。HDR腔内后装治疗宫颈癌,提高疗效,减少晚期并发症的关键是应用足够的分割(包括次数及剂量),但晚反应组织损伤、远期生存率有待进一步随访及评诂。Objective To apply unconventional fractionation to intracavitary brachytherapy,explore the possibility and biological effect in clinic.Methods 65cases①For stageⅡb,tumor dose was 40 Gy in 4 wks(20fractions);for stageⅢb,tumor dose was46Gy in4.6wks(23fractions);②Afterwards,patients were irradiated by4fields with central shielding(Pb5HVL3～4cmwide),anterial and posterial portals to give a boost dose of 12～16 Gy.1.2～1.5Gy.1.2～1.5W(point B).Intracavitary therapy was given with HDR(point A).③(Ⅱb、Ⅲb)received 3.3 Gy perfraction,twice daily of intracavitary irradiation at point A.The intrafraction interval was more than 6 hours in one day.The total dose at point A was 1980 cGy in six fractions.3 day.1.5 wks.④At the same time of central shielding,external irradiation,HDR-intracavitary brachytherapy was carried on alternately.Results Early vagina reaction(modified Fowler’s skin reactions)was as follows:Ⅰ°40 cases(62%),Ⅱ°19 cases(30%) and Ⅲ°6 cases(8%),The reaction did not cause any break-up of treatment.By the end of radiotherapy,local control was as follows:CR52 cases(80%),PR13 cases(20%),NC0 case,PD0 case.All65cases are surviving well nowwith follow-up,In follow-up local recurrence has not been observed,hematuria and bloody stool have not been complained.Conclusion The enough fractionation including fraction number and dose per fraction were very important for impoving treatment effect and decreasing late complications of the HDR intracavitary brachytherapy for cervix carcinoma.We think that the method above was applicable as it proved satisfactory early effects.Further follow-up is needed to evaluate its survival rate as well as late tissue injury.

关 键 词：宫颈癌 后装治疗 高剂量率 超分割 

分 类 号：R737.33[医药卫生—肿瘤]