局部晚期宫颈癌调强放射治疗同步化疗的临床研究
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摘要
目的:初步探讨调强放射治疗( intensity-modulated radiation therapy,IMRT)同步化疗治疗局部晚期宫颈癌(locally advanced cervical cancer,LACC)的近期疗效及并发症的发生情况。
方法:搜集2007年01月～2009年10月期间,59例在广西医科大学第四附属医院放疗中心诊断为LACC,无明显心、肺、肾、肝功能异常、行根治性放射治疗的患者的临床资料。全部病例采用体外照射(External Beam Irradiation, EBRT)和腔内近距离照射的联合放疗方案:外照射采用6MV-X线,每日1次,每周5次,每次1.8～2.2Gy,共25～30次;腔内近距离照射采用高剂量率后装治疗,于外照射2-3周后开始,“A”点:7 Gy/次,共5～8次;后装治疗当天不行外照射。放疗时同步应用顺铂(Cisplatin, DDP)化疗,每周1次,每次40mg/㎡。实验组(A组)29例外照射采用全盆腔调强放疗( Intensity Modulated Whole Pelvic Radiotherapy, IM-WPRT);对照组(B组)30例外照射采用常规盆腔前后两野对穿等中心照射,组织量达20～30 Gy后,盆腔野中间挡铅(遮挡后装部位)。观察两组患者的近期疗效和并发症的发生情况。
结果:放疗后3个月评估疗效:A组有效率为96.6%,B组为96.7%,两组差异无统计学意义(x2=0.000, P=1.000)。早期并发症中,恶心、呕吐等胃肠道反应发生率A、B组分别为86.2%、93.3%(x2=0.225, P=0.635);直肠反应发生率分别为34.5%、56.7%(x2=2.924, P=0.087);膀胱反应发生率分别为10.3%、23.3%(x2=0.965, P=0.326);早期并发症中,两组差异均无统计学意义(P>0.05)。骨髓抑制发生率两组分别为72.4%、96.7%(x2=4.964, P=0.026),两组差异有统计学意义(P<0.05)。晚期并发症中,放射性直肠炎发生率分别为10.3%、43.3%(x2=8.119, P=0.004);放射性膀胱炎发生率为3.4%、26.7%(x2=4.484, P=0.034);两组差异有统计学意义(P<0.05)。
结论:IMRT技术用于治疗中晚期宫颈癌患者,是一种有效的手段,可以减少放射性损伤及急慢性副反应的发生,尤其是减少骨髓抑制和晚期并发症的发生,可以提高患者的生存质量。
Objective To discuss the short-term effect and complications of concurrent intensity-modulated radiotherapy (IMRT) and chemotherapy for locally advanced cervical cancer (LACC).
Methods From January 2007 to October 2009, 59 women diagnosed LACC were treated with radical radiotherapy in the Department of Radiation Oncology , the fourth Affiliated Hospital of the Guangxi Medical University. All the patients without the disfunction of the heart、lung、liver and kidney . Retrospective these patients’informations of clinical . All patients were treated with the combination of EBRT plus afterloading Intracavitary irradiation : EBRT were performed with 6MV-X ray in 25 to 30 fractions with a fractionted 1.8～2.2Gy Gy perday , five days per week ; After loading intracavitary irradiation was done in 5 to 8 fractions with a fractionted 7Gy per week to“A”from second or third week , and that day EBRT was not performed . concurrent chemotherapy with DDP at the dose of 40mg/㎡ once a week . The treatment group (group A) included 29 cases , who had undergone IM-WPRT . The control group (group B) included 30 cases , who had undergone two field opposed (anteroposterior) conventional external , after a dose of 20～30Gy to the whole pelvis were given , pulsing midplane blocking of lead (block the part of afterloading ). Short-term effect and complications were observed.
Results Three month after radiotherapy , effective rate was 96.6% in group A and 96.7% in group B respectively(x2=0.000, P=1.000), showing no significant difference . Among the early complications , it was discovered that the incidence rates of gastrointestinal (nausea、vomiting and etc) side reaction was 86.2% in group A and 93.3% in group B respectively(x2=0.225, P=0.635); The incidence rates of rectum side reaction was 34.5% in group A and 56.7% in group B respectively(x2=2.924, P=0.087)and bladder side reaction was10.3% in group A and 23.3% in group B(x2=0.965, P=0.326). The early complications showed no significant difference(P > 0.05) ; The incidence rate of myelosuppression was 72.4%、96.7% respectively(x2=4.964, P=0.026), showed significant difference(P<0.05). The incidence rates of radiation proctitis was 10.3%、43.3% respectively(x2=8.119, P=0.004)and radiocystitis was 3.4%、26.7%(x2=4.484, P=0.034), showing significant difference in the late complications(P<0.05).
Conclusions TMRT is feasible in treating of LACC for its reductions of radiation damage and complications , especially decreasing the incidence rates of myelosuppression and late complications , improving the patients’quality of life .
方法:搜集2007年01月～2009年10月期间,59例在广西医科大学第四附属医院放疗中心诊断为LACC,无明显心、肺、肾、肝功能异常、行根治性放射治疗的患者的临床资料。全部病例采用体外照射(External Beam Irradiation, EBRT)和腔内近距离照射的联合放疗方案:外照射采用6MV-X线,每日1次,每周5次,每次1.8～2.2Gy,共25～30次;腔内近距离照射采用高剂量率后装治疗,于外照射2-3周后开始,“A”点:7 Gy/次,共5～8次;后装治疗当天不行外照射。放疗时同步应用顺铂(Cisplatin, DDP)化疗,每周1次,每次40mg/㎡。实验组(A组)29例外照射采用全盆腔调强放疗( Intensity Modulated Whole Pelvic Radiotherapy, IM-WPRT);对照组(B组)30例外照射采用常规盆腔前后两野对穿等中心照射,组织量达20～30 Gy后,盆腔野中间挡铅(遮挡后装部位)。观察两组患者的近期疗效和并发症的发生情况。
结果:放疗后3个月评估疗效:A组有效率为96.6%,B组为96.7%,两组差异无统计学意义(x2=0.000, P=1.000)。早期并发症中,恶心、呕吐等胃肠道反应发生率A、B组分别为86.2%、93.3%(x2=0.225, P=0.635);直肠反应发生率分别为34.5%、56.7%(x2=2.924, P=0.087);膀胱反应发生率分别为10.3%、23.3%(x2=0.965, P=0.326);早期并发症中,两组差异均无统计学意义(P>0.05)。骨髓抑制发生率两组分别为72.4%、96.7%(x2=4.964, P=0.026),两组差异有统计学意义(P<0.05)。晚期并发症中,放射性直肠炎发生率分别为10.3%、43.3%(x2=8.119, P=0.004);放射性膀胱炎发生率为3.4%、26.7%(x2=4.484, P=0.034);两组差异有统计学意义(P<0.05)。
结论:IMRT技术用于治疗中晚期宫颈癌患者,是一种有效的手段,可以减少放射性损伤及急慢性副反应的发生,尤其是减少骨髓抑制和晚期并发症的发生,可以提高患者的生存质量。
Objective To discuss the short-term effect and complications of concurrent intensity-modulated radiotherapy (IMRT) and chemotherapy for locally advanced cervical cancer (LACC).
Methods From January 2007 to October 2009, 59 women diagnosed LACC were treated with radical radiotherapy in the Department of Radiation Oncology , the fourth Affiliated Hospital of the Guangxi Medical University. All the patients without the disfunction of the heart、lung、liver and kidney . Retrospective these patients’informations of clinical . All patients were treated with the combination of EBRT plus afterloading Intracavitary irradiation : EBRT were performed with 6MV-X ray in 25 to 30 fractions with a fractionted 1.8～2.2Gy Gy perday , five days per week ; After loading intracavitary irradiation was done in 5 to 8 fractions with a fractionted 7Gy per week to“A”from second or third week , and that day EBRT was not performed . concurrent chemotherapy with DDP at the dose of 40mg/㎡ once a week . The treatment group (group A) included 29 cases , who had undergone IM-WPRT . The control group (group B) included 30 cases , who had undergone two field opposed (anteroposterior) conventional external , after a dose of 20～30Gy to the whole pelvis were given , pulsing midplane blocking of lead (block the part of afterloading ). Short-term effect and complications were observed.
Results Three month after radiotherapy , effective rate was 96.6% in group A and 96.7% in group B respectively(x2=0.000, P=1.000), showing no significant difference . Among the early complications , it was discovered that the incidence rates of gastrointestinal (nausea、vomiting and etc) side reaction was 86.2% in group A and 93.3% in group B respectively(x2=0.225, P=0.635); The incidence rates of rectum side reaction was 34.5% in group A and 56.7% in group B respectively(x2=2.924, P=0.087)and bladder side reaction was10.3% in group A and 23.3% in group B(x2=0.965, P=0.326). The early complications showed no significant difference(P > 0.05) ; The incidence rate of myelosuppression was 72.4%、96.7% respectively(x2=4.964, P=0.026), showed significant difference(P<0.05). The incidence rates of radiation proctitis was 10.3%、43.3% respectively(x2=8.119, P=0.004)and radiocystitis was 3.4%、26.7%(x2=4.484, P=0.034), showing significant difference in the late complications(P<0.05).
Conclusions TMRT is feasible in treating of LACC for its reductions of radiation damage and complications , especially decreasing the incidence rates of myelosuppression and late complications , improving the patients’quality of life .
引文
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[3] Bhargava R , Beriwal S , Dabbs DJ. Mammaglobin vs GCDFP-15 an immunohistologic validation survey for sensitivity and specificity .AM J Clin Pathol , 2007,127:103-113.
[4] GERSZTEN K ,COLONELLOK ,HERON DE , et al .Feast bility of concurrent cisplatin and extended field radiation therapy (EFRT) using intensity-modulated radiotherapy (IMRT) for carcinoma of the cervix [J]. Gyneocl Oncol , 2006,102(2) :182-188.
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