超分割后装治疗中晚期宫颈癌临床初步观察

Preliminary clinical observation of 192Ir hyperfractional brachytherapy for middle and advanced cervical cancer

目的观察192铱超分割后装治疗中晚期宫颈癌的近期疗效及并发症的发生情况,并列超分割后装与传统后装治疗效果及并发症进行比较。方法观察对象为2003年8月至2004年 1月间接受192铱超分割后装治疗的患者,共87例,其中ⅡB期29例,ⅢB期58例,每周治疗4次, 每次A点剂量1．5 Gy,每周累积剂量6 Gy,A点平均总剂量ⅡB期49．7 Gy,ⅢB期52．5 Gy。同时行10-15 MV-X线全盆体外照射,1．6～2 Gy／次,4次／周,外照射20～30 Gy后,中央挡铅4 cm,使盆腔外照射总量达52 Gy,总疗程8～10周。对照组选择2003年1月至2003年6月接受传统192铱后装治疗的患者89例,其中ⅡB期21例,ⅢB期68例,每周5-7 Gy／次,A点总剂量ⅡB期50．1 Gy,ⅢB期53．5 Gy。体外照射方案同超分割治疗。结果87例超分割后装治疗患者失访21例, 有效随访66例中,治疗结束时肿瘤局部控制率95％,1年生存率98％,2年生存率95％,其中ⅡB 期为100％,ⅢB期92％。放射性膀胱炎发生率8％,放射性直肠炎发生率15％。89例传统后装治疗患者失访29例,有效随访60例,1年生存率97％,2年生存率为95％,其中ⅡB期为100％,ⅢB 期93％。放射性膀胱炎发生率9％,放射性直肠炎发生率15％。结论超分割后装加盆腔外照射治疗Ⅱ、Ⅲ期宫颈癌,近期生存率较高,但与传统后装治疗近期疗效比较差异无显著意义,治疗过程中的局部炎性反应较重,不良反应率较高。

Objective To observe the short-term effects and complications of ^192Ir hyperfraetional braehytherapy in middle-advanced cervical cancer. Methods 87 patients with cervical cancer received hyperfraetional afterloading therapy between August 2003 and January 2004 were selected as observation group,including 29 eases of stage ⅡB,58 of stage ⅢB. The dose of point A was 1.5Gy/fraction,4 fractions per week,the total dose of reference point A was 49.7 Gy in stage Ⅱ B,52.5 Gy in stage ⅢB. The whole pelvic external irradiation was given with 10 - 15 MV X-ray, 1.6 -2 Gy/fraetion,4 fractions per week. After 20 - 30 Gy, the center of whole pelvic field was blocked by 4 em in width. The total dose of external radiotherapy was 52 Gy. 89 eases given traditional braehytherapy between January 2003 and June 2003 were selected as the control group,including 21 eases of stage Ⅱ B ,68 of stage Ⅲ B. The dose of point A was 5 - 7 Gy/fraction, 1 fraction per week. The total of point A dose was 50. 1 Gy in stage Ⅱ B,53.5 Gy in stage Ⅲ B. The pelvie irradiation was just as the observation group. Results In the observation group, the local eontrol rate of all followed up patients was 95% after treatment. The 1 year survival rate was 98% ,2 year survival rate was 95% , 100% for stage Ⅱ B,92% for stage m B. The late eomplieation rate was 8% for eystitis, 15% for proetitis. Out of 89 eases in eontrol group,29 eases were failed to be followed up,the 1 year survival rate was 97% ,2 year survival rate was 95% ,100% for stage Ⅱ B,93% for ⅢB. The late eomplieation rate was 9% for eystitis,15% for proetitis. Conclusion Combination of ^192Ir hyperfractional afterloading therapy and external radiotherapy ean get the high short-term survival rate in treating middle-advaneed eervieal eaneer,but there is not signifieant differenee between the two groups in short-term effeet, and the loeal inflammation reaetion and side effeets are more serious in observation group than in eontrol group.