Ⅱb～Ⅲb期子宫颈残端癌放疗方式的探讨  

Study of the radiotherapy modality for patients with stage Ⅱb～Ⅲb cervical stump cancer

作　　者：安菊生[1] 黄曼妮[1] 吴令英[1] 徐英杰[2] 李晓光[1] 俞高志[1] 杜霄勐 戴建荣[2] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院肿瘤研究所妇瘤科,100021 [2]中国医学科学院北京协和医学院肿瘤医院放疗科,100021

出　　处：《中华妇产科杂志》2013年第9期654-658,共5页Chinese Journal of Obstetrics and Gynecology

摘　　要：【摘要】目的探讨Ⅱb～Ⅲb期子宫颈残端癌的放疗方式。方法回顾性分析中国医学科学院北京协和医学院肿瘤医院2000年1月-2012年4月间收入院行放疗的13例Ⅱb～Ⅲb期子宫颈残端癌患者的临床资料，其中2006年前的8例患者采用体外常规放疗联合近距离腔内放疗（常规放疗组），2006年后的5例患者行体外三维适形调强放疗联合近距离腔内放疗（调强放疗组）。所有患者均进行随访，随访截止至2013年4月，随访时间为12～139个月，观察两组患者的复发与生存情况及近、远期并发症发生情况。结果（1）复发与生存情况：13例患者的中位总生存时间为31个月（12～139个月）。其中，常规放疗组（8例）患者的随访时间为13～139个月，中位总生存时间为57个月，中位无瘤生存时间为50个月，有3例患者于治疗后8～19个月复发，复发患者均因肿瘤多处转移死亡；调强放疗组（5例）患者的随访时间为12～82个月，中位总生存时间及无瘤生存时间均为21个月，5例患者均无瘤生存且无复发。（2）近、远期并发症：常规放疗组患者出现近期并发症7例（7／8），包括Ⅰ～Ⅱ级直肠反应5例、Ⅰ级膀胱反应2例；远期并发症5例（5／8），包括Ⅰ～Ⅲ级直肠反应3例、Ⅱ级膀胱反应2例。调强放疗组患者出现近期并发症1例（1／5），为Ⅰ级直肠反应；远期并发症1例（1／5），为Ⅰ级直肠反应。结论对Ⅱb～Ⅲb期子宫颈残端癌的放疗，合理采用体外三维适形调强放疗联合近距离腔内放疗模式，可能成为降低复发，减少近、远期放疗并发症发生的有效方法，但长期生存结果需进一步随诊后得出。Objective To investigate the radiotherapy modality progress of stage Ⅱb～Ⅲb cervical stump cancer. Methods The clinical data of 13 patients with stage Ⅱb～Ⅲb cervical stump cancer undergoing radiotherapy from January 2000 to April 2012 was reviewed. Before 2006, 8 patients received conventional external beam radiotherapy and brachytherapy. Since 2006, 5 patients received intensity- modulated radiotherapy （IMRT） and brachytherapy. Results The median smvival was 12 - 139 months. The median overall survivals and disease free survivals in the conventional radiotherapy （ CRT ） group were 57 months and 50 months, 3 cases of them recurred during 8 - 19 months and died of tumor progression. While, the median overall survivals and disease free survival in the IMRT group both were 21 months and nobody recurred. In the CRT group, 7 patients suffered toxicities,including 5 patients grade [ - l] acute rectum reaction,2 patients grade I bladder reaction; and 3 had grade Ⅱ～Ⅲ, late rectum reaction, 2 patients for grade H bladder late reaction. In the IMRT group,toxicities including 1 case grade I acute or late rectum reaction, and no bladder reaction. Conclusion In our experience,the recommended IMRT and interstitial brachytherapy for the selected patients with advanced cervical stump carcinoma may be obtain better tumor dose distribution and more sparing of the organ at risk.

关 键 词：宫颈肿瘤 肿瘤 残余 放射疗法 调强适形 近距离放疗 

分 类 号：R737.33[医药卫生—肿瘤]