新辅助化疗对比同步放化疗对宫颈癌放疗剂量影响的研究  

Study of radiotherapy dose effect of neoadjuvant chemotherapy versus concurrent chemoradiotherapy in cervical cancer

作　　者：李凤虎 梅烦 杜燕军 殷水水 田雪 胡丽丽 洪卫 单郎 班红 许聪凤 刘雯 卢冰 李杰慧 Li Fenghu;Mei Fan;Du Yanjun;Yin Shuishui;Tian Xue;Hu Lili;Hong Wei;Shan Lang;Ban Hong;Xu Congfeng;Liu Wen;Lu Bing;Li Jiehui(Department of Oncology,Affiliated Hospital of Guizhou Medical University,Guiyang 550004,China;Department of Gynecological Oncology,Affiliated Cancer Hospital of Guizhou Medical University,Guiyang 550004,China)

机构地区：[1]贵州医科大学附属医院肿瘤科,贵阳550004 [2]贵州医科大学附属肿瘤医院妇科肿瘤科,贵阳550004

出　　处：《中华放射肿瘤学杂志》2023年第2期131-137,共7页Chinese Journal of Radiation Oncology

基　　金：贵州医科大学附属肿瘤医院课题(YJ2019020)。

摘　　要：目的比较局部晚期大肿块(>4 cm)宫颈癌新辅助化疗对比同步放化疗对靶区及危及器官的影响。方法收集2019年3月1日至2021年6月30日期间经病理学证实的局部晚期宫颈癌患者146例,非盲数字表法按1∶1随机分成新辅助化疗(NACT)+同步放化疗(CCRT)组73例、CCRT组73例。NACT+CCRT组给予紫杉醇联合顺铂新辅助化疗2个周期后给予CCRT,CCRT组直接行CCRT。分类资料统计描述用率表示,两组计量资料比较采用两独立样本比较的Wilcoxon秩和检验,两组率或构成比比较采用χ^(2)检验。结果NACT+CCRT组与CCRT组放疗前GTV分别为(31.95±25.96)、(71.54±33.59)cm^(3),差异具有统计学意义(P<0.01),NACT+CCRT组放疗前CTV及PTV与CCRT组相比亦明显降低(P值均<0.05)。在靶区剂量学方面,NACT+CCRT组100%GTV接受的剂量(D_(100GTV))、95%CTV接受的剂量(D_(95CTV))、100%处方剂量包含的GTV百分比(V_(100GTV))、100%处方剂量包含的CTV百分比(V_(100CTV))及95%处方剂量包含的PTV百分比(V_(95PTV))与CCRT组相比明显提高(P值均<0.05)。NACT+CCRT与CCRT两组患者完全缓解(CR)率分别为86.3%、67.6%,差异有统计学意义(P<0.01)。在危及器官方面,NACT+CCRT组膀胱、直肠、小肠及尿道受照剂量与CCRT组相比明显降低(P值均<0.05)。结论新辅助化疗可缩小宫颈大肿块患者肿瘤体积,提高肿瘤受照剂量,同时降低周围危及器官剂量,降低了三维后装近距离治疗的难度,因此新辅助化疗联合同步放化疗可成为局部晚期大肿块宫颈癌患者治疗的新选择。Objective To compare the effect of neoadjuvant chemotherapy vs.concurrent chemoradiotherapy on the target volume and organs at risk for locally advanced bulky(>4 cm)cervical cancer.Methods From March 1,2019 to June 30,2021,146 patients pathologically diagnosed with cervical cancer were selected and randomly divided into two groups using random number table method:the neoadjuvant chemotherapy(NACT)+concurrent chemoradiotherapy(CCRT)group(n=73)and CCRT group(n=73).Patients in the NACT+CCRT group received 2 cycles of paclitaxel combined with cisplatin NACT,followed by CCRT,the chemotherapy regimen was the same as NACT.In the CCRT group,CCRT was given.Statistical description of categorical data was expressed by rate.The measurement data between two groups were compared by Wilcoxon rank-sum test for comparison of two independent samples,and the rate or composition ratio of two groups was compared byχ^(2)test.Results Before radiotherapy,GTV in the NACT+CCRT group was(31.95±25.96)cm^(3),significantly lower than(71.54±33.59)cm3 in the CCRT group(P<0.01).Besides,CTV and PTV in the NACT+CCRT group were also significantly lower compared with those in the CCRT group(both P<0.05).In terms of target volume dosimetry,D_(100GTV),D_(95CTV),V_(100GTV),V_(100CTV)and V_(95PTV)in the NACT+CCRT group were significantly higher than those in the CCRT group(all P<0.05).The complete remision(CR)rates in the NACT+CCRT and CCRT groups were 86.3%and 67.6%,with statistical significance between two groups(P<0.01).Regarding organs at risk,NACT+CCRT group significantly reduced the dose to the bladder,rectum,small intestine and urethra compared with CCRT group(all P<0.05).Conclusions NACT can reduce the volume of tumors in patients with large cervical masses,increase the radiation dose to tumors,reduce the dose to organs at risk,and make the three-dimensional brachytherapy easier.Therefore,NACT combined with CCRT may be a new choice for patients with locally advanced cervical cancer with large masses.

关 键 词：宫颈肿瘤 新辅助化学疗法 放化疗法 靶区剂量 危及器官 

分 类 号：R737.33[医药卫生—肿瘤]