HIFU治疗妇科晚期难治性复发性盆腔恶性肿瘤的评价

Evaluation of HIFU in Treating Advanced Recurrent or Refractory Pelvic Gynecologic Malignant Tumors

【目的】探讨高强度聚焦超声(HIFU)在妇科晚期难治性复发性盆腔恶性肿瘤治疗中的作用。【方法】选自2000年9月至2005年8月采用HIFU治疗妇科难治性复发性盆腔恶性肿瘤33例,与未经HIFU治疗的类似病例29例进行对照,根据既往的治疗史两组按相同的治疗标准选择化疗或放疗或化、放疗联合,制定个体化的治疗方案,对两组的治疗效果、复发情况、疾病无进展期、生存期及副反应及并发症进行比较。【结果】肿块消退情况:HIFU治疗组肿块消退有效率84.8%,明显高于对照组的55.2%(P<0.05)。临床症状改善:治疗前后KPS评分平均值分别为治疗组70.6分和76.0分,对照组68.9分和69.3分,两组治疗后比较差异有显著性(P<0.05)。复发情况:两组治疗有效的病例中治疗组复发率42.8%,对照组81.2%,两组比较差异有显著性(P<0.05)。治疗结束后至复发时的疾病无进展期治疗组平均12.7个月,对照组平均7.8个月,治疗组较对照组平均间隔时间延长了4.9个月(P<0.05)。生存期的影响两组比较差异无显著性(P>0.05)。副反应:消化道反应及骨髓抑制两组差异无显著性(P>0.05),但对照组比治疗组的并发症严重,发生率两组差异无显著性(P>0.05)。【结论】对晚期难治性复发性盆腔恶性肿瘤采用HIFU治疗,对肿瘤的局部“切除”或缩小有一定的疗效,特别是改善临床症状、提高生活质量、延长疾病无进展期有一定的辅助作用,其治疗安全、无创伤作为晚期患者综合治疗的手段之一有一定的价值,由于HIFU治疗对亚临床转移灶及晚期病人远处转移无效,对生存期的影响还有待进一步研究探索。

[Objective]To evaluate the effect of HIFU on recurrent or refractory pelvic gynecologic malignant tumors. [MethodslFrom Sept 2000 to Aug 2005, 62 patients with recurrent or refractory pelvic gynecologic malignant tumors were admitted to our hospital. By consistent standard based on prior treatment, all patients accepted individual treatment protocol including chemotherapy, radiotherapy or radiochemotherapy with or without HIFU. The therapeutical, toxic and adverse effects of either treatment with HIFU （study group, 33 cases） or without HIFU （control group, 29 cases） were analyzed and compared. [Results]Tumour subsidence condition： the effective rates were 84. 8% and 55.2% in study group and control group respectively, the difference was significant （ P〈0. 05）. Clinical symptom relief： pre- and post- therapeutic mean KPS were respectively 70. 6 and 76.0 in study group, 68.9 and 69. 3 in control group, the difference of pre- therapeutic mean KPS was not significant （ P〈0. 05）, but that of post- therapeutic mean KPS was significant （ P 〈0. 05）. Relapse condition： the recurrent rates of the patients were 42. 8% and 81.2% in study group and control groups respectively （ P 〈0. 05）. The PFS were 12. 7M and 7.8M in study group and control group respectively （ P 〈0. 05）. The difference of bone marrow suppression between two groups was not significant （ P 〈0. 05）. The differences of toxic and adverse effects between two groups were not significant （ P 〈0.05）. [Condusion]HIFU is safe and effective adjuvant means for the treatment of advanced recurrent or refractory pelvic gynecologic malignant tumors , that can reduce tumour bulk , improve clinical symptom and life quality, prolong PFS. Being of no effect for subclinic tumour or far away metastasis, HIFU effect on live period need more study.