同步放疗加化疗综合治疗宫颈癌的临床研究

Clinical study of synchronous radiotherapy and chemotherapy for cervical cancer

目的探讨同步化疗加放射治疗宫颈癌的疗效和不良反应。方法128例宫颈癌患者随机分为两组:同步放化疗和单纯放疗各64例。单纯放射治疗采用^(192)Ir高剂量率腔内加体外放射治疗,开始体外全盆腔照射,5次/周,2 Gy/次,盆腔平面中心剂量26 Gy-40 Gy,2.5.4.0周完成;然后中间挡铅,4个野照射,4次/周,2 Gy/次,宫旁剂量20 Gy-25 Gy;同时腔内治疗,1次/周,6 Gy/次,A点剂量为30 Gy-36 Gy。同步化疗加放疗组在放疗开始给予DF方案化疗即DDP50 mg/ m^2d1 5-Fu 4.0/m^2静注96 h,每4周重复,共3个周期。结果两组3、5年生存率,A组分别为73.4%和59.4%,B组分别为51.6%和43.7%(P<0.05)。早期放射性直肠反应发生率A组为15.6%,B组为12.5%,膀胱反应发生率A组为6.3%,B组为4.7%。A组远处转移率明显低于B组,A组的骨髓抑制和消化的道反应明显低于B组,但患者经一般处理均能耐受。结论同步化疗加放射治疗宫颈癌能提高患者的生存率,降低远处转移率。

Objective To investigate the clinical curative effects and side effect of chemo-radiotherapy for cervical cancer. Methods From January 1998 to December 2001,128 patients of cervical cancer were randomized into two groups： chemo- radiotherapy group （64 cases） and only radiotherapy group （64 cases）. Radiotherapy was given at the same time ,6-15 MVX ray was used for external radiation with a total DT of 26 - 40 Gy to the whol Pelvis and additional 20-25 Gy ; external beam radiation therapy to the parametrical were given. Intracavitary brachytherapy was delivered to a total dose of 36 -42 Gy at 6 Gy per fraction, once a week. Each patient of the chemo-radiotherapy group was given cisplatin hydration at the dose of 50 mg/m^2 dl ,plus 5-Fu 4.0/m^2 96 h ,once every 4weeks for 3 cycles. Results The effect rates of the chemo-radiotherapy and only radiotherapy groups were 89.1% and 62.5% respectively（ X^2 = 12. 302 ,P 〈 0.01 ）. The 3 ,Syear survival rates in patients of the chemoradiotherapy group and only radiotherapy group were 73.4% ,59.4% and 51.6% ,43.7% respectively（P 〈0.05）. Immediate rectal reaction and late radioproctitis in patients of the chemo- radiotherapy group and only radiotherapy group were present in 15.6%, 6.3% and 12.5% ,4.7% respectively. The rates of distant metastasis in chemo- radiotherapy group were lower than that in simple radiotherapy group, more section side effects were found in the chemo- radiotherapy group, especiously in bone marrow inhibition and reaction of digestive tract ,which could be alleviated. Conclusion Radiotherapy and chemotherapy concurrently can obviously increase the survival rate and decrease the rate of the distant metastasis.