两种不同腔内后装施源器治疗宫颈癌的临床观察

The clinical observation of the treatment of the cervical cancer with two different after loading applicator

目的:探讨高剂量率192Ir腔内后装时不同施源器治疗宫颈癌的疗效及膀胱、肠道晚反应并发症的发生情况。方法:127例宫颈癌患者予全盆外照DT45～50Gy配合腔内后装治疗,依照后装治疗时不同施源器分为固定Ⅲ管组62例,单宫腔管组65例。固定Ⅲ管组开始于全盆外照DT33Gy/18次,A点DT5～7Gy/次,1次/周,总量24～25Gy,6～8周内完成治疗。单宫腔管组开始于外照全盆DT38Gy/20次,A点DT6～7Gy/次,1次/周,总量21～25Gy,7～8周内完成治疗。结果:放疗结束后固定Ⅲ管组与单宫腔管组完全缓解病例分别为57例(91.94%)和58例(89.23%),5年生存率分别为66.13%(41/62)和61.50%(40/65),固定Ⅲ管组膀胱、肠道晚反应发生率分别为4.83%(3/62)和9.67%(6/62),明显低于单宫腔管组的10.76%(7/65)和21.53%(14/65)。结论:使用剂量曲线分布合理的固定Ⅲ管施源器行腔内放疗可以有效地治疗宫颈癌,并可明显减少膀胱、肠道晚反应并发症。

Objective：To explore the efficacy of uterine cervical cancer and late reaction complications of rectum and bladder with two different high dose rate 192 Ir afterloading intracavitary radiotherapy. Methods ： One hundred and twenty-seven cases of cervical cancer were treated by the combination of the whole pelvis external radiotherapy and afterloading technique. After the Dt 45-50Gy of the external radiation, they were randomly allocated into two groups according to the different brachytheraputie modality： the fixed threetube applicator group（62 patients） and single-tube applicator group （65 patients）. After the irradiation of whole pelvis with 50Gy, high dose rate intracavitary brachytherapy（HDRICB） with 192 Ir was performed using afterloading technique. The prescribed ＂Point A＂ dose in fixed three tube group were ranged from 5-7 Gy once a week, for 6-8 weeks, with the total dose of 24-25 Gy. And the ＂Point A＂ dose in single tube group were ranged from 6-TGy once a week, for 7-8 weeks, with the total dose of 21-25Gy. Results：After the radiotherapy, the cases of patients who got a complete remmision in the two groups were 57 （91.94%） and 58 （89.23%） , respectively. The total 5 year survival rate of two groups was 66. 13 % （41/62 ） and 61.50% （40/65）, respectively, which were very close. The incidence of radiation cystitis and rectitis in fixed three-tube applicator group was 5% and 10% respectively, and that of single-tube applicator group was 11% and 21% , respectively. The difference was significant between two groups. Conclusion： The radiation dose curve in the fixed three-tube brachytherapy was more rational than that of the single-tube one and the late complication of rectum and bladder were obviously decreased by that way.