全腹放疗应用于复发性卵巢癌综合治疗的初探  

Impact of whole abdomen radiation therapy integrated in the management of recurrent epithelial ovarian cancer

作　　者：汤洁[1] 蔡树模[1] 黄啸[1] 李子庭[1] 臧荣余[1] 

机构地区：[1]复旦大学附属肿瘤医院妇瘤科,复旦大学上海医学院肿瘤学系,上海200032

出　　处：《中国癌症杂志》2006年第11期931-935,共5页China Oncology

摘　　要：背景与目的：复发性卵巢癌治疗效果差，尚无统一的治疗方法。合理的综合治疗有可能提高疗效。本文旨在探讨全腹放疗在复发性卵巢癌综合治疗中的作用。方法：11例复发性卵巢癌采用铂类或紫杉醇为主的二线化疗，复发病灶较为局限于腹盆腔内者行二次肿瘤细胞减灭术，并在化疗达肿瘤缓解后给与全腹放疗。结果：全组二线化疗平均7个（5-11个）疗程，二线化疗后均获临床完全缓解。8例患者接受了再次肿瘤细胞减灭术，7例术后残留病灶≤1cm。化疗临床缓解后进行全腹分段超分割放疗，7例完成全部放疗计划，腹腔平均总量30．2Gy（29．96～31．2Gy），4例盆腔加量至45．1Gy（44．98～45．12Gy）。平均随访40．9月，中位生存时间超过60月，3年、5年总生存率分别为90．91％和81．82％。复发后3年生存率达72．73％。经二线治疗后再获临床缓解后，肿瘤再复发10例，中位无瘤生存时间22．0月，复发治疗后1～3年无瘤生存率分别为72．73％，45．45％和18．18％。1～3年腹盆腔内局部肿瘤控制率分别为72．7％（8／11），63．6％（7／11）和54．5％（6／11）。放疗期间主要毒性反应为骨髓抑制，Ⅲ级粒细胞毒性和Ⅲ级血小板毒性均为3例（27．3％）。胃肠道反应多数Ⅰ／Ⅱ级。随访远期毒性，1例出现持续性血小板下降（Ⅲ级），1例放疗后肠粘连引起肠梗阻。结论：初步结果表明复发性卵巢癌在二线化疗达临床缓解后加用全腹放疗可提高腹盆腔局部肿瘤控制率，延缓肿瘤的再复发，延长患者的生存期。全腹分段超分割放疗的急性反应较轻，多数患者可耐受。Background and purpose： As there is no agreed second-line treatment at relapse, patients with recurrent ovarian cancer often have a pessimistic outcome. Rational integrated therapy may improve the survival of patients in this setting. This prospective study was conducted to access the role of whole abdomen radiotherapy in recurrent patients. Methods： 11 patients with recurrent epithelial ovarian cancer received second-line chemotherapy, either platinum-based or paclitaxal-based regimen. Secondary debukling surgery was indicated to patients with limited and intra-abdominopelvic lesions. Additional whole abdomen irradiation was performed, by means of hyperfractionated and split course radiation. Results： 11 patients received mean 7 courses （5-11courses） second-line chemotherapy and all acquired complete response. Among 8 patients who underwent secondary debulking surgery, 7 cases acquired optimal cytoreduetion （the largest residual tumor ≤1cm）. After remission by the second-line chemotherapy, all patients received whole abdominal radiation. 7 patients completed the whole radiation therapy, with total dose of 30.2Gy（29.96-31.2Gy） to the abdomen and additional pelvic boost to 45. IGy （44.98-45.12Gy） in 4 cases. With mean follow-up of 40.9 months, the 3 and 5-year overall survival rate were 90.91% and 8 I. 82%, respectively. The median survival time was more than 60 months. The 3-year survival rate after recurrence was 72.73%. 10 women experienced tumor relapse again. Their median tumor-free survival was 22.0months, and 1-3 year tumor-free survival rate were 72.73%, 45.45% and 18.18%, respectively. 1-3 year local tumor control rate for the abdominal-pelvic cavity were 72.7% （8/11）, 63.6% （7/11） and 54.5% （6/11） , respectively. During irradiation, bone-marrow suppression was seen in all patients, with both Grade 3 neutropenia and Grade 3 thrombocytopenia in 3 cases （27.3%）. Acute gastrointestinal complication of radiotherapy was mild. Most patients had Grade Ⅰ/Ⅱ gastrointesti

关 键 词：卵巢肿瘤 癌 肿瘤复发 放射治疗 化学治疗 

分 类 号：R737.31[医药卫生—肿瘤] R730.55[医药卫生—临床医学]