后程三维适形放疗结合化疗治疗67例中晚期宫颈癌的临床观察

Clinical Observation of Late Course Three Dimensional Conformal Radiotherapy Combined with Chemotherapy for Locally Advanced Cervical Cancer

目的：探讨不作腔内后装治疗的中晚期宫颈癌采用后程三维适形放疗结合化疗的疗效。方法：67例宫颈癌随机分为三维适形放疗加化疗组31例（适形组）与常规放疗加化疗组36例（常规组），适形组患者均不作腔内后装治疗，先采用6MvX线全盆腔放疗DT 40Gy后采用三维适形放疗针对盆腔淋巴区及宫颈原发灶继续照射19Gv，最后再缩野针对宫颈原发灶推量，使宫颈原发灶总量达70～75Gy。常规组则采用全盆腔放疗40Gy后改为盆腔四野照射20Gy，腔内后装治疗A点剂量30Gy／5次，使宫颈原发灶A点达70Gv。两组均作同期化疗，方案为：顺铂30mgd1～3，5-Fu500mg／m^2，d1～5，静脉滴注，第1周、第5周各一次。结果：适形组和常规组1、2年生存率分别为93．5％、90.3％和833％、72．2％（P=0．198和P=0．062），无显著统计学意义。3年生存率分别为87．1％和61．1％（P=0．017），两组有显著的统计学意义。两组毒副作用比较，适形组Ⅰ～Ⅱ级放射性直肠炎及盆腔纤维化发生率低于常规组（P=0．000和P=0．015），其他的毒性相似。结论：后程三维适形放疗合并化疗治疗中晚期宫颈癌是一种有效、肯定的治疗方法，能提高患者近期生存率，晚期并发症较常规放疗低。3DCRT在宫颈癌放疗中的作用仍需大宗病例和长期随访来验证其优越性。

Objective： To explore the effect of late course three dimensional conformal radiotherapy （3DCRT） combined with chemotherapy on locally advanced cervical cancer in patients unsuitable for conventional intracavitary brachytherapy. Methods： Sixty-seven cervical cancer patients were randomly divided into two groups. The 31 cases in the 3DCRT group received 3DCRT plus chemotherapy. The 36 cases in the conventional group received conventional radiotherapy plus chemotherapy. In the 3DCRT group, a median total dose of 40 Gy was administered for whole pelvic irradiation, using 6 MV energy. The 3DCRT plans were opti- mized to deliver 19 Gy to the pelvic lymph nodes and local lesions, and then 3DCRT boosted the total dose to the local cervical cancer lesion up to 70-75 Gy. In the conventional group, after whole pelvic irradiation, the four-field technique was used to irradiate the parametrial tissue and regional nodes （a median dose of 20 Gy）, and then intracavitary brachytherapy （30 Gy/5 fraction） was performed. The total dose to the local cervical cancer lesions was 70 Gy. All 67 patients in the two groups received two cycles of chemotherapy concurrently with radiotherapy in the first week and the last week. Chemotherapy consisted of 5-Fluorouracil （500mg/m^2/d） infusion on days 1-5 and cisplatin （30 mg/d） infusion on days 1-3. Results： The 1- and 2-year survival rates were 93.5% and 90.3% in the 3DCRT group, and 83.3% and 72.2% in the conventional group, with no signifi- cant difference （P=0.198 and P=0.062）. The 3-year survival rate was 87.1% in the 3DCRT group and 61.1% in the conventional group, with a significant difference （P=0.017）. The side effects in the two groups were similar and well tolerated. The incidence of Ⅰ-Ⅱ grade rectal reaction and pelvic fibrosis was lower in the 3DCRT group than in the conventional group （P=0.000 and P=0.015）. Conclusion： Late course 3DCRT combined with chemotherapy is an effective and feasible approach for treating cervical cancer and can significantly improve short term survival. It also has a lower incidence of late complications. A larger sample size and longer follow-up are warranted to further investigate the value of 3DCRT in the treatment of cervical cancer.