高剂量率后装腔内放射合并手术治疗宫颈癌40例临床分析

Preoperative High Dose Rate Irradiation and Hysterectomy on 40 Patients with Careinoma of Uterine Cervix

目的探讨高剂量率后装腔内治疗的最佳方案及提高疗效。材料与方法1992年2月至1995年1月，40例Ⅰb期和Ⅱb期宫颈癌患者，在行60C0或8MV直线加速器体外照射加高剂量率后装治疗2～4周后，再行全子宫或次广泛子宫切除术。全盆外照射20Gy，A点总量60Gy左右，B点50Gy。手术标本全部送病检，作多点切片，观察标本有无癌生存及对放射线的反应程度。结果鳞癌28例，Ⅲ级反应20例，占71．4％，无Ⅰ级反应，腺癌和鳞腺癌12例Ⅲ级反应4例，占33．3％。Ⅰ级反应4例（P＜0．05），40例全部随诊3年以上，无癌生存35例，死亡5例。3年存活率87．50％，5年存活率81．50％。结论鳞癌疗效高于腺癌，腺癌可加大放疗剂量；对瘤体较大，内生型及腺癌宫颈癌患者，应全量放疗之后行简单子宫切除术。

:Objective To evalute the optimal regiment of cervical carcinoma treated by the combination of after load ing irradiation with external irradiation and improve its effectiveness its yeness. Methods 40 patients of stage Ⅰb and Ⅱ b were treated by Way of the combination of external irradiation with Co-60 or 8MV linear accelerator and intracavitary brachytherapy ,for 2 - 4 weeks folloWed by surgery.The for of external haliallon for the whole pelvic field was 20Gy, the total aviation daal was 60Gy(point A) ac 50Gy(point B). Biopsies were collected ac specimens able in watrra all the operan tions in order to trace cancer cells as well as the response to irradiation.Rusults All the patients were followed up for than 3 yare.The Irradiation response of I out Of the 28 cases with squamous cell carcinoma,grade Ⅲ wartgrawts had4 of the 12cases wb aderrim and adequanuostra areim.The difference in these typeswas haliallon two po was statiedcally intra arystcant(P < 0.05) .Conclusions The cases with cell ereinoma had a these effect than the cases with statpatiens accelerto adewi,for the latter, the irradiation dosse could be enlargedbefore irradiation sopry.[Weywords] high dose rate irradiation,cervical carcinoma ,adenocarcinoma