高剂量率后装腔内放射并手术治疗宫颈癌

Preoperative High Dose Rate Irradiation and Hysterectomy in Carcinoma of Uterine Cervix

自１９９２年２月至１９９４年１０月，我们对３２例Ⅱ期以内、局部瘤体较大、年纪较轻的宫颈癌病人，在行体外及高剂量率后装内放疗后３周左右，再行全子宫或次广泛子宫切除术。全组病例手术经过顺利，未发现任何并发症。本组３２例病人的切除标本全部送病检，作多点切片，观察有无癌组织存在并描述对射线反应的程度。３２例中，放疗反应Ｉ级者３例，Ⅱ级者１３例，Ⅲ级者历例。按病理类型分析，２３例鳞癌中Ⅱ级反应８例、Ⅲ级反应１５例（６５．２％）。８例腺癌中Ｉ级反应２例，Ⅱ级反应５例，Ⅲ级反应者仅１例。１例鳞腺癌为Ｉ级反应。术后随访２～３０个月未发现特殊并发症，３０例病人无癌生存，１例局部复发，１例左锁骨上转移。

From Feb.1992 to Oct. 1994,32 stage- Ⅱb cases of carcinoma of uterine cervix with bulky tumor mass were treated with external radiation(RT) and high dose rate irradiation(HDR).After 20Gy/2 wks,RT was given to the whole pelvis, HDR with 6Gy/wk for 7 weeks was given.The total dose was 60Gy and 50Gy at points A and B.The surgery was Performed 3 weeks after radiation. No operative complication was found.The histological findings were classified into Grades I,Ⅱ and Ⅲ.The criteria of classification and the number of patients in the present series was:grade I,slight or no degenerative changes were found in 3 cases; Grade Ⅱ, a large amount of degenerative tissue and viable cancer tissues rained in 13 cases; Grade Ⅲ, no cancer tissure or slight severely damaged cancer tissue was found in 16 cases.In 23 cases with squamous carcinoma the histologic grades were I in 0 case,Ⅱ in 8 cases and Ⅲ in 15 cases,while in 8 cases of adenocarcinoma/squamoadenocarcinoma g rade I had 2 cases,grade Ⅱ 5 cases and grade Ⅲ one case.The patients were follOWed for 2-30 months.No complications were found in them. Thirty cases are still living very well.One case had local recurrence and another with distant metastasis died at 18th month.