252锎中子腔内照射加外照射治疗宫颈癌110例临床分析  

Clinical analysis of combination of 252Cf neutron intracavitary brachytherapy and external beam radiotherapy for 110 cervical cancer patients

作　　者：布洁[1] 李韧[1] 宋微[1] 曹京旭[1] 王迎选[1] 

机构地区：[1]中国人民武装警察部队总医院肿瘤一科,北京100039

出　　处：《中华肿瘤杂志》2010年第8期619-621,共3页Chinese Journal of Oncology

摘　　要：目的 探讨252锎中子腔内照射加外照射治疗宫颈癌的疗效和并发症.方法 2002年11月至2007年11月间,252锎中子腔内照射加外照射治疗宫颈癌110例.全盆照射总剂量为20～30Gy后,中间挡铅4 cm,加量至45～54 Gy,每周4～5次,每次1.8 Gy.252锎中子腔内后装治疗采用SL（n）中子腔内治疗程序,每周1次腔内治疗,共6～10次,每次总剂量为6～8 Gy,A点总剂量为30～51 Gy,中位总剂量为42 Gy.结果 全组110例患者中位随访30个月,全组患者的3年总生存率为79.2%,其中Ⅰ期、Ⅱ期、Ⅲ期和Ⅳ期患者的3年生存率分别为50.0%、84.3%、53.7%和33.3%,Ⅱ 期和Ⅲ期患者间的差异有统计学意义（P＜0.05）.全组患者的3年无病生存率为76.2%,其中Ⅱ期和Ⅲ期患者的3年无病生存率分别为80.4%和53.7%.全组患者的3年局部控制率为90.0%.治疗前血红蛋白水平正常者的3年生存率为78.2%,贫血者为42.4%,两组间差异有统计学意义（P＜0.05）.病理类型为鳞癌和腺癌患者的3年生存率分别为78.5%和76.9%,肿瘤直径＜4 cm和≥4 cm患者的3年生存率分别为71.2%和68.1%,行介入治疗和未行介入治疗者的3年生存率分别为53.3%和74.5%,差异均无统计学意义（均P＞0.05）.全组晚期放射性肠炎的发生率为11.8%,放射性膀胱炎的发生率为2.7%.结论 252锎是一种较好的腔内治疗的放射源,对于宫颈腺癌、直径≥4 cm的宫颈肿瘤以及受中子影响较大区域病变的治疗具有优势.Objective To evaluate the curative effect and complication of 252Cf brachytherapy on cervical cancer. Methods From Nov 2002 to Nov 2007, 110 cervical cancer patients were treated by combination of 252 Cf neutron intracavitary brachytherapy and external beam radiotherapy. There were 2 cases of stage Ⅰb, 5 stage Ⅱa, 57 stage Ⅱb, 2 stage Ⅲa, 41 stage Ⅲb,2 stage Ⅳa,and 1 stage Ⅳb. The whole pelvic cavity was irradiated with 8 MV X-ray, 1.8 Gy/fraction, 4-5 times per week. The total dose of external beam radiotherapy was 40-50 Gy （ the center of whole pelvic field was blocked by 4 cm in width after 20-30 Gy）. 252Cf neutron intracavitary brachytherapy was delivered at 6-8 Gy（i）/fraction, and the total dose of reference point A was 30-51 Gy （i）. The median dose was 42 Gy （i）. Results The overall 3-year survival rate of all patients was 79.2%, and the local control rate was 90.0%. In particular, the 3-year survival rate was 1/2 for stage Ⅰ, 84.3% for stage Ⅱ,53.7% for stage Ⅲ. The difference between stage Ⅱ and stage Ⅲ was statistically significant （P 〈 0.05 ）. The 3-year survival in cervical lesions larger than or equal to 4 cm and those less than 4 cm was 68.1% and 71.2%, respectively （ P 〉 0.05 ）. The 3-year survival rate of patients with and without anemia was 42.4% and 78.2% , respectively （ P 〈 0.05 ）. The 3-year survival rate of patients with squamous cell carcinoma and adenocarcinoma was 78.5% and 76.9%,respectively （ P 〉 0.05 ）. The late radiation complications of rectum and bladder was 11.8% （13/110） and 2.7% （3/110）, respectively. Conclusion It is concluded that 252Cf is a better source for intracavitary brachytherapy. According to our initial experience, 252Cf has advantages of a high local control rate,especially to bulky tumor and adenocarcinoma.

关 键 词：宫颈肿瘤 锎 放射疗法 

分 类 号：R686[医药卫生—骨科学]