Ⅰb_2Ⅱa期子宫颈癌腔内放疗加手术与单纯手术治疗的临床对比分析

Comparison of the Effects of Preoperative Vaginal Intracavitary Irradiation plus Surgery and Surgery Alone for Stage Ⅰb2 and Ⅱa Cervical Cancer

目的:比较术前近距离腔内后装放疗和单纯手术治疗Ⅰb2、Ⅱa期宫颈癌的疗效,以探讨Ⅰb2、Ⅱa期宫颈癌术前适当剂量阴道腔内放疗的意义。方法:选取北京妇产医院1998年6月至2005年6月,Ⅰb2、Ⅱa期且宫颈肿块均>4cm的宫颈癌患者78例。患者随机分为两组:术前放疗组38例行术前192Ir近距离腔内放疗,阴道盒源旁1cm2000～3000cGy,分2～3次/2～3周完成,放疗后10～14天行宫颈癌根治术即广泛子宫切除+盆腔淋巴结清扫术;单纯手术组40例直接行宫颈癌根治术。评定两组的疗效和术前阴道腔内后装放疗对手术的影响及术后并发症的情况。结果:术前放疗组宫颈肿块均有不同程度的缩小,总有效率(CR+PR)94.7%(36/38),术前放疗组和单纯手术组相比未增加手术难度和术后并发症,两组局部控制率分别为1年(89.5%和80.0%,P>0.05)、3年(82.9%和61.3%,P<0.05)、5年(76.9%和52.6%,P<0.05);两组1、3和5年生存率分别为(85.0%和92.1%,P>0.05)、(83.9%和87.9%,P>0.05)和(78.3%和80.0%,P>0.05),差异无显著性。结论:术前近距离阴道腔内后装放疗可作为Ⅰb2、Ⅱa期宫颈癌综合治疗的一种有效的治疗方法,对Ⅰb2、Ⅱa期宫颈癌有满意的局部控制率。

Objective： To compare the outcome of preoperative vaginal intracavitary irradiation plus surgery and that of surgery alone for patients with stage Ⅰ b2 and Ⅱ a cervical cancer, and to determine the value of preoperative vaginal intracavitary irradiation in patients treated by radical hysterectomy and pelvic lymphadenectomy for stage Ⅰ b2 and Ⅱa cervical cancer. Methods： From June 1998 to June 2005, data from 78 stage Ⅰ b2 and Ⅱ a cervical cancer patients （age≤75 years） with a diameter of local lesions greater than 4 cm were collected in our hospital. Before treatment, all cases were confirmed by biopsy. The patients＇ general state was good, KPS grade≥90, heart and lung functioning was normal and patients were able to tolerate the surgery. The 78 patients were randomly divided into two groups. Group 1 （n=38） received 2000-3000 cGy ^92Ir irradiation from preoperative intracavitary brachytherapy （radioactive source at 1 cm distance）. After a rest of 10 to 14 days, radical hysterectomy with pelvic lymphadenectomy was performed. Group 2 （n=40） underwent radical surgery directly. The treatment outcomes between these two groups were compared and the effect of preoperative intracavitary brachytherapy and presence of postoperative complications were evaluated. Results： In group 1, the tumor volume shrunk after irradiation and the total response rate （CR＋PR） was 94.7% （36/38）. Preoperative intracavitary brachytherapy did not increase the rate of complications. The 1-, 3- and 5-year Iocoregional control rates were 89.5%, 82.9% and 76.9% in group 1 and 80.0%, 61.3% and 52.6% in group 2. A significant difference was found in the 3- and 5-year Iocoregional control rates between the two groups （P〈0.05）. There was no significant difference between the two groups in the 1-, 3- and 5-year survival rates： 85.0% vs. 92.1% （P〉0.05）, 83.9% vs. 87.9% （P〉0.05）, and 78.3% vs. 80.0% （P〉0.05）, respectively. Conclusion： Preoperative intracavitary brachytherapy is an effective procedure for the treatment for stage Ⅰ b2 and Ⅱ a cervical cancer and can significantly improve the Iocoregional control rate.