调强适形放射治疗对宫颈癌放疗后腹主动脉旁淋巴结转移的疗效分析

Intensity Medulated Radiation Therapy for Para-aortic Lymph Node Metasteses in Carcinoma of the Cervix after Definitive Radiotherapy

目的回顾性分析调强适形放射治疗（IMRT）对宫颈癌放疗后腹主动脉旁淋巴结转移的疗效。方法2003年4月至2006年6月,对26例经影像学检查证实腹主动脉旁淋巴结转移的患者进行分析,中位年龄44.77岁（25-67岁）。中位出现腹主动脉旁淋巴结转移时间为13.6个月。单个转移灶11例,2个转移灶7例,多个转移灶8例。8例接受了4-6个周期的化疗。腹主动脉旁淋巴结转移灶处方剂量为45 Gy,分次剂量300cGy;亚临床病灶处方剂量为37.5Gy,分次剂量250cGy。结果中位随访时间20个月。转移灶和亚临床病灶的平均剂量分别为44.2 Gy和36.5Gy。治疗后2个月的完全有效率100.0%（26/26）。1、3年总生存率分别为58.8%、23.2%。4例出现3级毒副反应,对症治疗后明显好转。结论IMRT能使腹主动脉旁淋巴结转移灶获得理想的剂量分布,减少周围正常组织接受照射的体积,副反应小,是1种有效的治疗方法。

Objective To study the effect of intensity modulated radiation therapy（IMRT） in the treatment of patients with para-aortic lymph node（PALN） metasteses after definitive radiotherapy of cervical carcinoma.Methods 26 patients with para-aortic lymph node metastases receiving IMRT from April 2003 to June 2006,were analyzed retrospectively.The median age was 44.77years（range 25～67years）.All patients were diagnosed by CT,MRI or PET-CT image scan.The median period to PALN metastases from the time of initial treatment was 13.6 months.11 patients had solitary node metastasis,and 15 patients had more than one node metastases.IMRT was given with PLATO-system.The prescribed dose was 45Gy to gross tumor volume（GTV）,37.5Gy to clinical target volume（CTV）.8 patients received 4 to 6 cycles cisplatin-based chemotherapy.Result 2 months after treatment,34.6%（9/26） patients had complete response and 65.4%（17/26） patients had partial response.The 1-,3-year overall survival rate were 58.8% and 23.2%,respectively.Grade 3 hematologic toxicities developed in 4 patients.5 cases experienced Grade 2 nausea.7 patients developed distant metastases.Conclusion MRT produced ideal dose distribution with significant sparing of the kidneys,small bowel and other normal structures.It could be regarded as an effective treatment modality without significant acute or late toxicity.