淋巴结≥2 cm的晚期宫颈癌患者后程缩野加量调强放疗的疗效观察  

Clinical Observation of Late Course Shrinking Field Radiotherapy with Intensity Modulated Radiotherapy for the Diameter of the Lymph Node≥2 cm in the Patients with Advanced Cervical Cancer

作　　者：刘雅雯 章玲玲 李凌[1] 涂海燕[1] LIU Yawen;ZHANG Lingling;LI Ling(Jiangxi Maternal and Child Health Hospital,Nanchang,330006)

机构地区：[1]江西省妇幼保健院,330006

出　　处：《实用癌症杂志》2021年第4期668-671,共4页The Practical Journal of Cancer

基　　金：2018年江西省卫生健康委科技计划(编号:20185411)。

摘　　要：目的比较淋巴结直径≥2 cm的局部晚期宫颈癌患者接受调强放疗(IMRT)时选择后程缩野加量或同步加量照射的疗效及不良反应。方法入组153例经病理确诊为宫颈癌,伴盆腔和(或)腹主动脉旁淋巴结转移且直径≥2 cm的患者,调强放疗(IMRT)时随机接受后程缩野加量(n=76)及同步加量(n=77)照射。后程缩野加量组:计划靶体积(PTV):45 Gy/25 F/1.8 Gy,完成治疗后行第2次CT定位扫描,仅勾画可见肿瘤靶体积(GTV)即转移淋巴结:14.4 Gy/8 F/1.8 Gy。同步加量组:PTV:45 Gy/25 F/1.8 Gy,GTV:同步加量至60 Gy/25 F/2.4 Gy。结果后程缩野加量组与同步加量组相较,两组近期有效率为82.9%vs.87%;远期有效率分别为77.6%vs.81.8%(P>0.05);复发率为15.8%vs.13%(P>0.05)。两组均未出现Ⅲ~Ⅳ级的近期及远期放射性反应。其中,两组患者Ⅰ~Ⅱ级的近期放射性反应主要为放射性皮炎(1.3%vs.3.9%;P<0.05)、放射性肠炎(3.9%vs.15.6%;P<0.05)、放射性胃炎(1.3%vs.5.2%;P<0.05)、放射性膀胱炎(6.5%vs.1.3%;P<0.05)。Ⅰ~Ⅱ级的远期放射性反应主要为放射性肠炎(7.8%vs.1.3%;P<0.05)、放射性膀胱炎(3.9%vs.1.3%;P<0.05)。结论对于淋巴结≥2 cm的局部晚期宫颈癌患者,后程缩野加量放疗疗效并不劣于同步加量放疗,但不良反应的发生率却明显低于后者。因此后程缩野加量放疗或可成为该部分患者的临床选择。Objective To compared the clinical effect and toxicity of simultaneously integrated boost intensity modulated radiotherapy and late course shrinking field modulated radiotherapy for the patients with the diameter≥2 cm of pelvic and abdominal lymph node metastasis in cervical cancer.Methods The clinical data of cervical cancer patients with the diameter≥2 cm of pelvic and abdominal lymph node metastasis was collected.Patients were randomly assigned to late course shrinking field modulated radiotherapy group(n=76)and simultaneously integrated boost intensity modulated radiotherapy group(n=77).For the patients received the pelvic field planning dose was 45~50 Gy in 25 fractions in late course shrinking field modulated radiotherapy group.After the first plan,the second computed tomography scan(CT)localization scan was performed and boost the dose of 14.4/8 F/1.8 Gy for Gross Tumor Volume as positive lymph nodes(GTV).The patients received 45~50 Gy in 25 fractions for the pelvic field planning dose,and a simultaneously integrated boost intensity modulated radiotherapy of 60 Gy in 25 fractions was delivered to GTV in another group.Results The short-term efficacy rate was 82.9%vs.87%between late course shrinking field modulated radiotherapy group and simultaneously integrated boost intensity modulated radiotherapy group.The long-term effective rate of the two groups was 77.6%vs.81.8%(P>0.05).The recurrence rate in both groups was 15.8%vs.13%(P>0.05).GradeⅢ~Ⅳadverse events were not observed in either group.Among them,the acute adverse reactions of gradeⅠ~Ⅱwere mainly radioactive dermatitis(1.3%vs.3.9%;P<0.05),radiation enteritis(3.9%vs.15.6%;P<0.05),radioactive gastritis(1.3%vs.5.2%;P<0.05),radioactive cystitis(6.5%vs 1.3%;P<0.05).The major chronic adverse reactions of gradeⅠ~Ⅱwere radiation enteritis(7.8%vs.1.3%;P<0.05),radioactive cystitis(3.9%vs.1.3%P<0.05).Conclusion Forthe patients with the diameter≥2 cm of lymph node in advanced cervical cancer,the efficacy of late course shrinking field modulated

关 键 词：宫颈癌 淋巴结≥2 cm 后程缩野放疗 同步加量 

分 类 号：R737.33[医药卫生—肿瘤]