3D打印微创导向模板插植放射治疗联合深部热疗治疗局部晚期宫颈癌的疗效分析  

Efficacy analysis of 3D-printed minimally invasive-guided template interstitial radiotherapy combined with deep hyperthermia in the treatment of locally advanced cervical cancer

作　　者：侯光营 苗珺珺[1] 胡建伟[1] 郜蕾[1] 张永侠[1] 袁香坤[1] HOU Guangying;MIAO Junjun;HU Jianwei;GAO Lei;ZHANG Yongxia;YUAN Xiangkun(Department of Radiotherapy and Chemotherapy,Hebei Province Cangzhou Hospital of Intergrated Traditional and Western Medicine,Cangzhou 061000,China)

机构地区：[1]河北省沧州中西医结合医院放化疗二科,沧州061000

出　　处：《中国癌症防治杂志》2022年第1期76-81,共6页CHINESE JOURNAL OF ONCOLOGY PREVENTION AND TREATMENT

摘　　要：目的探讨3D打印微创导向模板插植放射治疗联合深部热疗治疗局部晚期宫颈癌的近期疗效和不良反应。方法选取2018年6月至2020年12月于河北省沧州中西医结合医院治疗的80例初治宫颈癌患者,并随机分为联合治疗组及单纯治疗组,每组40例。单纯治疗组外照射采用6 MV-X加速器放疗同步顺铂化疗,后装治疗采用^(192)Ir高剂量率通用施源器腔内放疗,大体肿瘤靶区照射30~36 Gy,5~6次,6 Gy/次,1次/周。联合治疗组外照射及同步化疗同单纯治疗组,插植放射治疗在3D打印微创导向模板引导下进行,总剂量及分次剂量同单纯治疗组,每次插植治疗结束2 h内联合深部热疗。比较两组患者的近期疗效和不良反应,以及90%靶区体积剂量(D90)、100%处方剂量体积百分比(V100)、危及器官膀胱和直肠2 cm^(3)体积的受照剂量(D_(2) cm^(3))。结果治疗结束2个月后,联合治疗组患者完全缓解率明显高于单纯治疗组(92.5%vs 72.5%,χ^(2)=4.242,P=0.039),但部分缓解率和疾病稳定率差异无统计学意义(χ^(2)=2.635,P=0.193;χ^(2)=3.117,P=0.241)。与单纯治疗组相比,联合治疗组高危临床靶区的V100、D90均明显升高[(79.83±6.31)%vs(87.35±4.38)%,t=6.685,P<0.001;(5.89±0.24)Gy vs(6.32±0.21)Gy,t=7.584,P<0.001],危及器官直肠D2 cm^(3)的平均剂量明显降低[(3.50±0.27)Gy vs(3.25±0.36)Gy,t=-3.406,P=0.002],但膀胱D_(2) cm^(3)的平均剂量差异无统计学意义[(4.42±0.18)Gy vs(4.37±0.25)Gy,t=-0.961,P=0.343]。两组患者1~2级放射性直肠炎、放射性膀胱炎以及3级放射性膀胱炎的发生率比较差异均无统计学意义(均P>0.05),但联合治疗组3级放射性直肠炎发生率较单纯治疗组明显降低(χ^(2)=3.914,P=0.048)。结论在局部晚期宫颈癌治疗中,应用3D打印微创导向模板插植放射治疗联合深部热疗治疗较传统通用施源器三维腔内后装放射治疗的近期疗效显著提高,不良反应较轻,在靶区受照剂量及危及器Objective To investigate the short-term efficacy and adverse reactions of 3D-printing minimally invasive-guided template implantation radiotherapy combined with deep hyperthermia in the treatment of locally advanced cervical cancer.Methods A total of 80 patients with cervical cancer newly treated in Hebei Province Cangzhou Hospital of Intergrated Traditional and Western Medicine from June 2018 to December 2020 were randomly divided into a combination treatment group and a single treatment group,with 40 cases in each group.In the single treatment group,the external irradiation was performed with 6 MV-X accelerator radiotherapy and cisplatin chemotherapy,the post loading treatment was treated with^(192)Ir high-dose rate universal source intracavitary radiotherapy,and the general tumor target area was irradiated 30-36 Gy,5-6 times,6 Gy each time,once a week.The external irradiation and synchronous chemotherapy in the combination treatment group were the same as those in the single treatment group;the implantation radiotherapy was performed under the guidance of 3D-printed minimally invasive-guided template,and the total dose and fractional dose were the same as those in the single treatment group;the deep hyperthermia was combined within 2 h after each implantation treatment.The short-term efficacy and adverse reactions of the two groups were compared,with regard to 90%target volume dose(D90),100%prescription dose volume percentage(V100),and the exposure dose to 2 cm^(3) volume of bladder and rectum in organs at risk(D_(2) cm^(3)).Results Two months after the treatment,the complete remission rate in the combination treatment group was significantly higher than that in the single treatment group(92.5%vs 72.5%,χ^(2)=4.242,P=0.039),whereas there was no significant difference in partial remission rate and stable disease rate(χ^(2)=2.635,P=0.193;χ^(2)=3.117,P=0.241).Compared with those of the single treatment group,the V100 and D90 of high-risk clinical target volume in the combination treatment group were significant

关 键 词：宫颈癌 3D打印微创导向模板 插植放射治疗 深部热疗 

分 类 号：R737.33[医药卫生—肿瘤]