腔内微波热疗联合放疗治疗中晚期宫颈癌临床观察

Clinical observation of intracavitary microwave hyperthermia combined with radiotherapy for advanced cervical cancer

目的观察腔内微波热疗加放疗治疗宫颈癌的临床疗效。方法66例宫颈癌患者随机分为热疗加放疔组（热放组）33例，单纯放疗组（单放组）33例。两组放射治疗方法相同，均采用8Mv—X线全盆腔外照射DT30Gy，盆腔4野DT20Gy，加^192Ir高剂量率腔内后装治疗，A点DT42Gy。热疗采用915MHz微波热疗仪，放疗后30min～1h内进行，腔内加温43—45℃，每次45min，每周1～2次，共7～10次。结果热放组与单放组局部控制率、感染率分别为87．88％和63．63％、15．15％和36．36％，差异均有统计学意义（P〈0．05），热放组治疗后CD4／CD8比值及自然杀伤细胞数较治疗前升高（P〈0．05），与单放组比较差异有统计学意义（P〈0．05）。2年肿瘤无进展生存率及3年生存率热放组与单放组分别为93．94％和72．72％、84．85％和60．61％，差异均有统计学意义（P〈0．05）。骨髓抑制及放射性直肠炎发生率热放组均低于单放组。结论腔内微波热疗联合放疗能提高宫颈癌的局部控制率及生存率。

Objective To evaluate the clinical effect of intraeavitary microwave hyperthermia combined with radiotherapy for advanced cervical cancer. Methods 66 patients were randomized into two groups ：33 patients treated by radiotherapy plus hyperthermia （H ＋ R group） , 33 patients treated by radiotherapy alone （R group）. Radiotherapies of both groups were alike：a midplane dose of 30 Gy to the whole pelvis and 20 Gy to the parametrical areas were given by using 8 MV-X rays, combined with 42 Gy with ^192Ir high dose rate（HDR） intracavitary braehytherapy. Intraluminal 915 MHz microwave hyperthermia was given 30 rain to 1 h after radio- therapy. The temperature was increased and maintained at 43-45 ℃ for 45 minutes, once or twice a week for 7- 10 times. Results The rates of local control and infection in H ＋ R and R groups were 87.88% and 63.63%, 15.15% and 36. 36% respectively. The differences of the two groups were statistically significant（ P 〈0.05）. In H ＋ R group, the level of CD4/CD8 and NK cells after being treated were higher than those before being treated and that of R group（ P 〈 0. 05）. The rates of 2-year disease-free survival and 3-year survival for H ＋ R and R groups were 93.94% and 72. 72% ,84. 85% and 60. 61% respectively. The differences of the two groups were statistically significant（ P 〈0. 05 ）. The rates of bone marrow inhibition and radiatory rectum injury were lower in H ＋ R group than those in R group. Conclusion Hyperthermia plus radiotherapy can improve local control rate and survival rate in advanced cervical cancer.