术前腔内放射治疗子宫内膜癌60例疗效观察  

Combined Treatment of Intracativity Irradiation Techniques and Surgery for Stage Ⅰ～ⅡEndomertrial Carcinoma

作　　者：孔为民[1] 孙建衡[1] 

机构地区：[1]中国医学科学院肿瘤医院妇瘤科,北京妇产医院肿瘤科100021

出　　处：《实用癌症杂志》2002年第1期74-76,79,共4页The Practical Journal of Cancer

摘　　要：目的　评价腔内后装放疗加全子宫双附件切除治疗子宫内膜癌的疗效 ,观察腔内后装放疗的效果 ,并分析影响疗效的因素。方法　对 60例腔内放疗后行手术治疗的子宫内膜癌患者 ,通过计算其 5年生存率及分析手术标本以观察其疗效。放疗应用Buchler或WD HDR 18后装放疗机 ,放疗总量 :F点给予 40 .0～ 49.5Gy ,A点给予 3 2 .0～ 46.1Gy。于放疗后 8～ 14周行全子宫及双附件切除术 ,术后根据病理结果给予适当辅助治疗。结果　 60例的 5年生存率为 88.3 % ,其中Ⅰ期为 88.0 % ,Ⅱ期为88.6%。放疗后手术标本病理结果显示 :60例中无肿瘤残留 2 2例 ,出现轻度放射反应 6例 ,中度放射反应 8例 ,重度放射反应 16例 ,不详 8例。病理类型、细胞分化程度是影响其疗效的因素。子宫内膜癌临床期别 (Ⅰ、Ⅱ期 )不影响治疗效果。残存肿瘤中 ,5 /8例次发生在宫底、宫角。结论　子宫肉膜癌腔内后装放疗后行以全子宫双附件切除为主的手术治疗可获得良好的治疗效果 ,不良反应较少。腔内放疗有效率较高。治疗时应强调治疗的规范性 ,应特别注意宫底和宫角的剂量分布。对低分化腺癌、浆液性乳头状腺癌及腺鳞癌等高危病理类型病例 。Objective To evaluate the combined therapy efficacy of afterloading techniques and surgery in endometrial carcinoma;and find the prognostic factors of endometrial carcinoma.Methods Intracavitary irradiation was administered to 60 patients with endometrial carcinoma stage Ⅰ～Ⅱ by Buchler or WD HDR18 8～14 weeks before operation.The dose at point F was 40.0～49.5 Gy.The dose at point A was 32.0～46.1 Gy.Results The overall 5 year survival rate was 88.3%,with 88.0% for stage Ⅰ and 88.6% for stage Ⅱ.The pathology of the specimen from surgery showed:there were 22 cases without residual tumor,6 cases with lighter degree of radiation reaction,8 cases with middle degree of radiation reaction and 16 cases with higher degree of radiation reaction.The degrees of radiation action were significantly lower in the so called high risk pathology type than those with 'ordinary type'.Those with lower degree of differentiation had a slighter degree of radiation action.In all 8 cases with residual tumor and slighter degree of radiation action,there were 5 cases,their with residuat tumor occurred were in the fundi and corners of uteri.Conclusion The effects of intracavity radiotherapy followed by surgery are satisfactory for endometrial carcinoma stage I Ⅱ,and the efficacy rate of intracavity radiotherapy is high.However,the dose distribution of the fundi and corners of uteri must be paid more attention.Besides,improvement of the treatment protocols is needed for those with high risk pathology types.

关 键 词：子宫内膜癌 术前放疗 腔内放射疗法 疗效观察 

分 类 号：R737.33[医药卫生—肿瘤] R730.55[医药卫生—临床医学]