早期高危宫颈癌术后IMRT同期或序贯化疗临床研究  

A comparative clinical study of postoperative intensity-modulated radiotherapy combined with concurrent and sequential chemotherapy for high-risk early-stage cervical cancer

作　　者：聂芳芳[1] 王丽华[3] 滕银成[2] 王玉东[4] 付杰[1] 

机构地区：[1]上海交通大学附属第六人民医院肿瘤放疗科,200233 [2]上海交通大学附属第六人民医院妇产科,200233 [3]上海交通大学医学院附属国际和平妇幼保健院妇科肿瘤科,200030 [4]上海交通大学医学院附属国际和平妇幼保健院妇科,200030

出　　处：《中华放射肿瘤学杂志》2018年第5期473-477,共5页Chinese Journal of Radiation Oncology

基　　金：上海申康医院发展中心促进市级医院临床技能与临床创新能力三年行动计划（16CR3112B）;上海市第六人民医院预研基金项目（LYZY-0122）;上海市第六人民医院预研基金项目（LYZY-0190）

摘　　要：目的评价早期高危宫颈癌患者术后IMRT同期化疗或序贯化疗疗效和急性不良反应。方法回顾分析2009-2017年收治的105例早期（ⅠB1-ⅡA2）高危宫颈癌术后患者临床资料，将患者分为IMRT同期化疗（C-IMRCT）组73例和IMRT序贯化疗（S-IMRCT）组32例。比较两组5年DFS、OS率及复发率、转移率和急性不良反应。采用Kaplan-Meier法计算生存率并Logrank检验和单因素预后分析，复发、转移、不良反应比较采用连续性校正爿。检验。结果C．IMRCT、S-IMRCT组中位随访时间分别为20、23个月（P=0．813）。C-IMRCT、S-IMRCT组5年DFS分别为72．6％、72．5％（P：0．918），OS分别为82．8％、78．5％（P=0．504）。两组复发、转移情况均相近（P=0．598、1．000）。单因素预后分析未显示病理因素影响患者预后。急性不良反应主要为1、2级急性血液学毒性且两组总发生率相近（46．6％：41．9％，P=0．884），胃肠道反应（腹泻）、尿路感染均相近（P=0．854、0．271）。结论IMRT同期化疗治疗早期高危宫颈癌术后患者的生存率值得临床进一步研究。Objective To evaluate the efficacy and acute toxicities of postoperative intensity- modulated radiotherapy （IMRT） combined with concurrent （C-IMRCT） or sequential chemotherapy （S- IMRCT） in the treatment of high-risk early-stage cervical cancer. Methods A retrospective study was performed on the clinical data of 105 patients with high-risk early-stage （ ⅠB1- Ⅱ A2） cervical cancer from 2009 to 2017. Those patients were divided into C-IMRCT group （n = 73） and S-IMRCT group （n = 32）. The 5-year disease-free survival （DFS） and overall survival （OS） rates, recurrence rate, metastasis rate, and acute toxicities were compared between the two groups. The survival rates were calculated by the Kaplan- Meier method and analyzed by the log-rank test. Univariate prognostic analysis was performed by the log-rank test. Recurrence, metastasis, and adverse reactions were compared using continuous correction chi-square test. Results The median follow-up time was 20 and 23 months in the C-IMRCT group and the S-IMRCT group, respectively （P= 0. 813）. There were no significant differences in the 5-year DFS and OS rates between the two groups （72.6% vs. 72.5%, P=0.918;82.8% vs. 78.5%, P=0.504）. There were no significant differences in the recurrence and metastasis rates between the two groups （P= 0.598; P= 1. 000）. The univariate prognostic analysis showed that no pathologicai factor affected prognosis. There were no significant differences in the incidence rates of grade 1-2 hematological toxicity, diarrhea, and urinary tract infection between the two groups （46. 6% vs. 41.9%, P=0. 884;P=0. 854;P=0. 271）. Conclusions Further clinical studies are needed in terms of the survival rate in patients with high-risk early-stage cervical cancer receiving C-IMRCT.

关 键 词：宫颈肿瘤/调强放射疗法 宫颈肿瘤/化学疗法 同期放化疗法 序贯放化疗法 预后 

分 类 号：R737.33[医药卫生—肿瘤]