调强放疗联合后装治疗的老年宫颈癌患者不良反应和预后因素分析  

Major adverse events and prognostic factors in elderly patients with cervical cancer undergoing intensive-modulated radiotherapy combined with intravaginal brachytherapy

作　　者：王坚[1] 胡莉钧[2] 于波[1] 王利利[3] 于静萍[2] 孟庆红[2] 孙志强[2] 汪建林[2] Wang Jian;Hu Lijun;Yu Bo;Wang Lili;Yu Jingping;Meng Qinghong;Sun Zhiqiang;Wang Jianlin(Department of Radiation Oncology,Jiangyin People's Hospital,Affiliated Hospital of Southeast University,Jiangyin 214400,China;Department of Radiation Oncology,Changzhou Second People's Hospital Affiliated to Nanjing Medical University,Changzhou 213003,China;Department of Radiation Oncology,the First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]东南大学附属江阴市人民医院放疗科,江阴214400 [2]南京医科大学附属常州市第二人民医院放疗科,常州213003 [3]苏州大学附属第一医院放疗科,苏州215006

出　　处：《中华老年医学杂志》2019年第10期1148-1152,共5页Chinese Journal of Geriatrics

基　　金：南京医科大学科技发展基金重点项目(2017NJMRZ039)。

摘　　要：目的观察老年宫颈癌患者调强放疗+腔内照射±化疗的不良反应和疗效,分析其预后影响因素。方法回顾性分析214例接受三维技术外照射+腔内照射±化疗的≥60岁宫颈癌患者的临床资料和随访结果。Kaplan-Meier法计算生存(OS)率,Log-rank法行预后单因素分析和Cox法行预后多因素分析。结果同步放化疗和单纯放疗患者3级以上骨髓抑制发生率分别为48.6%和15.8%,两组比较差异有统计学意义(χ2=27.372,P<0.05)。同步放化疗和单纯放疗患者完全缓解(CR)率分别为83.0%和68.3%,两组比较差异有统计学意义(χ2=5.993,P=0.014)。全组1、3和5年OS率分别为92.2%、79.3%和65.6%。单因素分析显示,患者FIGO分期、淋巴结转移状况、病理类型和近期疗效是影响患者预后的因素(χ2=4.321~30.316,均P<0.05)。多因素分析显示,FIGO分期、淋巴结转移状况、近期疗效是影响患者预后的独立因素(χ2=5.284~14.261,均P<0.05)。结论老年宫颈癌患者采用调强放疗+腔内照射±化疗的治疗模式可取得良好的疗效和长期OS率,治疗毒副反应可耐受。FIGO分期、淋巴结转移状况、近期疗效是影响老年宫颈癌患者预后的独立因素。Objective To investigate the adverse effects and clinical efficacy of the intensive modulated radiotherapy(IMRT)and intravaginal brachytherapy combined with versus without chemotherapy in elderly patients with cervical cancer,and to analyze its prognostic factors.Methods Clinical data and follow-up results of 214 patients with cervical cancer aged≥60 years undergoing IMRT and intravaginal brachytherapy combined with or without chemotherapy were retrospectively analyzed.The overall survival(OS)rate was calculated by using the Kaplan-Meier method.Prognostic factors were analyzed by Log-rank single factor test and Cox multivariate analysis.Results The rates of myelosuppression(≥grade 3)was higher in the concurrent chemo-radiotherapy group than in simple radiotherapy group(48.6%vs.15.8%,χ2=27.372,P<0.05).The complete response(CR)rate was higher in the concurrent chemo-radiotherapy group than in the simple radiotherapy group(83.0%vs.68.3%,χ2=5.993,P=0.014).The 1-,3-and 5-year OS rate were 92.2%,79.3%and 65.6%,respectively in all patients.Univariate analysis showed that the staging,lymph node metastasis status,pathological type and short-term efficacy of cervical cancer(based on FIGO guideline)were influencing factors for the prognosis(χ2=4.321-30.316,all P<0.05).Multivariate analysis showed that the FIGO staging,lymph node metastasis status and short-term efficacy were independent influencing factors for the prognosis(χ2=5.284-14.261,all P<0.05).Conclusions The intensive modulated radiotherapy and intravaginal brachytherapy combined with chemotherapy have a good efficacy and favorable long-term survival rate for the treatment of cervical cancer in elderly patients,and its major adverse effects can be tolerated.The FIGO staging,lymph node metastasis status and short-term efficacy are independent influencing factors for the prognosis in elderly patients with cervical cancer.

关 键 词：宫颈肿瘤 放射疗法 预后 

分 类 号：R73[医药卫生—肿瘤]