IORT在宫颈癌治疗中的应用体会

Application of intraoperative radiotherapy for cervical cancer

目的:对术中放射治疗(IORT)在宫颈癌患者中的应用进行初步评价。方法:回顾性分析181例宫颈癌患者应用IORT后的效果。结果:在9例宫颈癌复发患者中,1例IORT后9个月因全身多发转移死亡;1例在IORT后14个月阴道残端复发,余7例IORT后均无瘤生存至今。172例IORT宫颈癌Ⅱb期患者,5年无瘤生存率、5年生存率、5年局部控制率分别为86.5%、89.7%、94.5%;按鳞癌、腺癌、腺鳞癌分类,其5年生存率分别为93.2%、91.7%、56.0%。术后发生与IORT相关的并发症少且经保守治疗后大多可自愈。结论:IORT有很好的肿瘤原发部位的局部控制效果,不仅对宫颈复发癌是一项可供选择的治疗手段,对于Ⅱb期宫颈癌初治患者选择“经腹全子宫双附件切除术+选择性盆腔淋巴结剥除术+IORT”也是一项有进步意义的综合治疗方案。

Objiective： To preliminarily assess the application effects of intraoperative radiation therapy （IORT） for cervical cancer. Methods：To analyze retrospectively the effect of 181 cervical cancer patients with IORT. Results：In 9 cases, 1 died after IORT nine months because of multiple metastases, 1 case metastasised in vagina stump after IORT fourteen months. The other seven had survived with free diseases up to now. In 172 patients with cervical cancerⅡ b, 5 -year disease free survival rate, 5 -year survival rate and 5-year local control rate were 86. 5% , 89. 7% and 94. 5%, respectively. According to squamous carcinoma, adenocarcinoma and adenosquamous carcinoma, the 5 -year survival rate were 93.2%, 91.7% and 56% , respectively. The complications dependent on IORT after operation were few and most of them could be self-treated. Conclusion：The effect of IORT for primary site of tumor is good. IORT not only is selected for recurrence of cervical cancer, but also suitable for cervical cancer Ⅱ b. IORT can improve obviously 5 -year survival rate of cervical carcinoma especially cervical adenocarcinoma. There is positive significance for patients of cervical cancer Ⅱ b to select ＂utero-adnexectomy plus selective lymphadenectomy plus IORT＂.