160例Ⅱb期宫颈癌术前光子线＋术中电子线照射的远期疗效分析

Long-term outcome of 160 patients with stage Ⅱb cervical carcinoma treated with pre-operative and intra-operative radiotherapy

目的 分析宫颈癌Ⅱb期患者应用术前外照射＋192Ir腔内照射＋手术及术中电子线照射的远期疗效.方法 对160例应用术前外照射＋192Ir腔内照射＋手术及术中电子线照射的宫颈癌Ⅱb期患者资料进行回顾分析.全部患者术前先全盆腔接受了20 Gy分10次外照射和192Ir近距离腔内放疗,1周后全盆腔接受了12 MeV电子线18～20 Gy照射.结果 随访率为98.1%.随访满5、10年患者分别为143、135例.5年和10年生存率、无瘤生存率、局部控制率分别为89.4%、86.3%、96.3%和84.4%、81.0%、95.0%.放射性直肠炎、膀胱炎发生率分别为5.0%、0.6%.放疗后肾孟积水、下肢水肿发生率分别为6.3%、1.3%.结论 宫颈癌Ⅱb期患者应用术前外照射＋192Ir腔内照射＋手术及术中电子线照射可提高患者生存率,且对肿瘤原发部位局部控制效果好,放疗副反应少.

Objective To investigate the 5-and 10-year survival and complications of patients with stage Ⅱb cervical carcinoma treated by pre-operative photon radiotherapy （POPRT） plus brachytherapy （192Ir） and selective lymphadenectomy hysterectomy （SLH） plus intra-operative electron radiotherapy （IOERT）. Methods From February 1997 to May 2007, 160 patients with stage Ⅱb cervical carcinoma were treated by POPRT of 20 Gy in 10 fractions to the whole pelvis, 192Ir brachytherapy of 14 Gy in 2fractions, followed by IOERT of 18 -20 Gy to the whole pelvis during SLH one week after. Results The follow-up rate was 98.1%. The number of patients followed-up for 5 and 10 years was 143 and 135,respectively. The 5-year overall survival rate, disease-free survival rate and local control rate of all patients were 89.4%, 86. 3% and 96. 3%, with the corresponding 10-year rates of 84.4%, 81.0% and 95.0%,respectively. The radiation-induced rectitis and cystitis were 5.0% and 0. 6%, respectivly. The rate of hydronephrosis and lower extremity edema was 6. 3% and 1.3%, respectively. Conclusions Combination of EBRT plus 192Ir brachytherapy and SLH plus IOERT could improve the survival and local control of patiens with cervical carcinoma, with only a few side effects.