同步加量调强放射治疗在ⅢCr期宫颈癌阳性淋巴结中的应用  

The application of simultaneous integrated boost intensity-modulated radiotherapy in positive lymph nodes of stageⅢCr cervical cancer

作　　者：班红 李杰慧 杜燕军 胡丽丽 洪卫 梅烦 田川 李凤虎 Ban Hong;Li Jiehui;Du Yanjun;Hu Lili;Hong Wei;Mei Fan;Tian Chuan;Li Fenghu(Department of Oncology,the Affiliated Hospital of Guizhou Medical University,Guiyang 550001,China;Department of Gynecological Oncology,Affiliated Cancer Hospital of Guizhou Medical University,Guiyang 550001,China)

机构地区：[1]贵州医科大学附属医院肿瘤科,贵阳550001 [2]贵州医科大学附属肿瘤医院妇科肿瘤科,贵阳550001

出　　处：《国际放射医学核医学杂志》2024年第12期789-796,共8页International Journal of Radiation Medicine and Nuclear Medicine

基　　金：贵州省抗癌协会科技计划项目(014[2023])。

摘　　要：目的探讨基于调强放射治疗(IMRT)技术的同步加量治疗对ⅢCr期宫颈癌阳性淋巴结的疗效和安全性。方法收集2020年1月至2022年10月在贵州医科大学附属肿瘤医院诊治的82例ⅢCr期(ⅢC1r期和ⅢC2r期)宫颈癌阳性淋巴结患者进行横断面研究, 患者年龄(52.3±10.5)岁。上述患者应用IMRT技术进行治疗, 其中宫颈肿块和转移淋巴结分别接受50.4 Gy/28次和60.2 Gy/28次放射治疗。同时, 患者接受4~6周期顺铂或2周期紫杉醇+顺铂方案化疗, 并联合30.0 Gy/6次的三维后装近距离治疗。观察患者的近期疗效、生存情况、放化疗不良反应。计数资料采用秩和检验, 采用Kaplan-Meier曲线估算患者生存率, 采用COX回归分析评估各临床病理特征对患者生存时间和结局的影响。结果 82例患者的中位随访时间为27个月(范围9~44个月)。近期疗效评价显示完全缓解率为79%(65/82), 部分缓解率为21%(17/82), ⅢC1r期和ⅢC2r期患者的客观缓解率均为100%(71/71、11/11)。所有患者的2年和3年总生存率均为92%, 2年和3年无进展生存率分别为79%和74%。COX回归分析结果显示, 国际妇产科联盟分期为宫颈癌阳性淋巴结患者无进展生存的独立预后因素(HR=4.099, 95%CI:1.174~14.311, P=0.027)。急性3级和4级放化疗后骨髓抑制的发生率分别为52.4%(43/82)和6.1%(5/82);3例患者出现3级急性放射性肠炎, 表现为肠梗阻及腹泻。结论基于IMRT的同步加量技术在ⅢCr期宫颈癌阳性淋巴结患者的治疗中获得良好的临床疗效, 且不良反应在可接受范围内。Objective To explore the efficacy and safety of simultaneous integrated boost therapy that is based on intensity-modulated radiotherapy(IMRT)technology for stageⅢCr cervical cancer-positive lymph nodes.Methods Eighty-two patients with stageⅢCr(ⅢC1r andⅢC2r)cervical cancer-positive lymph nodes diagnosed and treated in the Affiliated Cancer Hospital of Guizhou Medical University from January 2020 to October 2022,with the age of 52.3±10.5 years,were collected for a cross-sectional study.These patients were treated by applying IMRT,in which the cervical mass and metastatic lymph nodes were treated with 50.4 Gy/28F and 60.2 Gy/28F radiotherapy,respectively.The patients received 4–6 cycles of cisplatin or two cycles of paclitaxel+cisplatin regimen chemotherapy combined with 30.0 Gy/6F three-dimensional afterloading brachytherapy.The recent efficacy,survival,and adverse reactions of radiotherapy and chemotherapy were observed,and counting data were tested by rank-sum test.Kaplan-Meier curves were used to estimate patient survival,and COX regression analysis was used to assess the impact of each clinicopathological feature on patient survival time and outcome.Results The median follow-up of the 82 patients was 27 months(range of 9–44 months).Recent efficacy evaluations showed a complete remission rate of 79%(65/82),a partial remission rate of 21%(17/82),and objective remission rates of 100%(71/71,11/11)for patients with stagesⅢC1r andⅢC2r.The 2-and 3-year overall survival rates of all patients were 92%,and the 2-and 3-year progression-free survival rates were 79%and 74%,respectively.The results of COX regression analysis showed that International Federation of Gynecology and Obstetrics stage was an independent prognostic factor for progression-free survival in patients with cervical cancer-positive lymph nodes(HR=4.099,95%CI:1.174–14.311,P=0.027).The incidence of acute grades 3 and 4 myelosuppression after radiotherapy and chemotherapy were 52.4%(43/82)and 6.1%(5/82),respectively.Grade 3 acute radiatio

关 键 词：宫颈肿瘤 淋巴转移 调强放射治疗 不良反应 治疗结果 

分 类 号：R737.33[医药卫生—肿瘤] R730.55[医药卫生—临床医学]