宫颈癌术后调强放疗的效果  

Clinical study of intensity-modulated radition therapy for patients with cervical cancer after surgery

作　　者：方绳权[1] 陈海燕[1] 高敏[2] 熊世禄[1] 张慧峰[1] 杨润峰[1] 

机构地区：[1]湖北省肿瘤医院妇瘤科,湖北武汉430079 [2]武汉大学中南医院放化疗科,湖北武汉430071

出　　处：《中国医药导报》2016年第12期104-108,共5页China Medical Herald

基　　金：湖北省自然科学基金资助项目(ZRY1445)

摘　　要：目的探讨调强放射治疗在宫颈癌术后补充治疗中的效果。方法选择2012年2月~2013年4月湖北省肿瘤医院及武汉大学中南医院治疗的因宫颈癌术后有高危因素而需要补充治疗的82例患者进行前瞻性对比研究,随机将其分为两组,对照组(普通放射治疗组)42例,实验组(调强放射治疗组)40例。调强放射治疗具体方法:处方剂量95%计划靶体积≥45 Gy,每日1次,1.8 Gy/次,每周5次,共25次;普通放射治疗方法:等中心照射,处方总剂量(DT)45 Gy,每日1次,1.8 Gy/次,每周5次,共25次。阴道残端高剂量率内照射,参考点位于阴道黏膜下0.5 cm,驻留1.5 cm,3 Gy/次,每周2次(或者阴道黏膜下0.5 cm,驻留1.5 cm,7 Gy/次,每周1次),DT 21 Gy。放疗期间同步化疗,化疗方案为顺铂(40 mg/m^2),每周1次,共5~6个周期。治疗结束后对患者进行随访,观察患者的无瘤生存率、生存率,及治疗后近、远期不良反应。结果所有患者均顺利完成放疗,1年随访率为100%。实验组1年无瘤生存率为92.5%,对照组1年无瘤生存率为90.5%,两组差异无统计学意义(P>0.05);两组1年生存率均为100%,差异无统计学意义(P>0.05)。治疗后近期不良反应:实验组骨髓抑制(55.0%)、肠道反应(47.5%)、泌尿系反应(27.5%)发生率均低于对照组(90.5%、81.0%、54.8%),差异均有统计学意义(P<0.05或P<0.01)。治疗后晚期不良反应:实验组肠道反应(17.5%)、泌尿系反应(5.0%)发生率均低于对照组(57.1%、52.4%),差异均有高度统计学意义(P<0.01)。结论调强放射治疗应用于宫颈癌术后放疗较传统普通放疗具有一定优势,通过较精确照射局部靶区,能够有效保护危及器官的同时,还能有效减少放射损伤,进而提高患者生存质量,具有较强的临床应用和推广价值。Objective To study the effect of intensity-modulated radiation therapy （IMRT） for patients with cervical cancer after surgery. Methods From February 2012 to April 2013, a total of 82 patients with adverse factors need replacement therapy after cervical cancer surgery were selected for prospective comparative study, and they were divided into IMRT group （40 cases） and routine radiotherapy group （conventional group, 42 cases） randomly. Concrete method of IMRT： the 95% of planning target volume≥45 Gy, once-daily, 1.8 Gy/fraction, 5 times/week, 25 fractions in total; routine radiotherapy： isocenter irradiation, with the total dose of 45 Gy, once-daily, 1.8 Gy/fraction, 5 times/week, 25 fractions in total. High dose rate brachytherapy in vaginal stump： the reference point was located at the vaginal mucosa 0.5 cm, resident 1.5 cm, 3 Gy/fraction, and 2 times/week （or vaginal submucosal 0.5 cm, 7 Gy/fraction, 1 times/week）, the total dose of 21 Gy. Concurrent chemotherapy during radiotherapied, chemotherapy with cisplatin was given by intra- venous drip once a week, with the dose of 40 mg/m2 body surface area for 5-6 weeks. All the patients were followed- up, rate of disease-free survival, survival, and the near and future adverse reactions after treatment were observed. Re- suits All patients were successfully completes radiotherapy, rate of one-year follow-up was 100%. Rate of the one-year survival in the IMRT group was 92.5%, and rate of the one-year survival in the control group was 90.5%, there was no significant difference between two groups （P 〉 0.05）; rate of one-year survival in two groups was 100%, there was no significant difference （P 〉 0.05）. Recent adverse reactions after treatment： the incidence of bone marrow inhibition （55.0%）, gut reaction （47.5%）, urinary tract （27.5%） were lower than those of the control group （90.5%, 81.0%, 54.8%）, the differences were statistically significant （P 〈 0.05 or P 〈 0.01）. Late adverse reactions after treatment

关 键 词：宫颈肿瘤 同期放化疗 调强放射治疗 术后放疗 

分 类 号：R737.33[医药卫生—肿瘤]