三维放疗联合顺铂同期化疗局部晚期宫颈癌疗效分析

Therapeutic efficacy of three-dimensional conformal radiotherapy combined with concurrent weeklycisplatin-based chemotherapy for locally advanced cervical cancer

目的分析CT图像为基础三维适形放疗联合顺铂同期化疗对晚期宫颈癌患者疗效及副反应情况。方法回顾分析2007--2008年本科收治的181例Ⅱ。～Ⅳ。期宫颈癌患者资料，其中年龄32～82岁（中位数50岁）。放疗采用以CT图像为基础的三维适形放疗和三维^192。Ir后装照射技术，同期联合顺铂单药每周化疗方案。结果随访中位数34个月，随访率为92．2％。全组患者3年总生存率为73．4％、无瘤生存率为70．4％、盆腔控制率为91．3％。肿瘤直径≥4cm和〈4cm者总生存率分别为66．9％和86．4％（X^2=6．29，P=0．012）。RTOG分级急性胃肠道副反应1、2级发生率分别为40．0％、45．O％，泌尿系副反应1、2级发生率分别为19．9％、4．4％。RTOG分级晚期下消化道副反应3＋4级发生率为4．9％。结论以CT图像为基础三维适形放疗和三维^192Ir后装照射技术联合顺铂同期化疗对局部晚期宫颈癌患者疗效较好，并对降低晚期严重副反应的发生有益。

Objective To analyze the therapeutic efficacy and treatment related toxicities for patients with locally advanced cervical cancer treated with three-dimensional conformal radiotherapy （3DCRT） combined with concurrent chemotherapy. Methods From January 2007 to February 2008, 181 patients with stage IIA-IVA cervical cancer were retrospectively analyzed. All patients were treated with CT- based three-dimensional external beam and 192Ir intraeavity radiotherapy combined with concurrent weekly cisplatin-based chemotherapy. The median age was 50 years （range, 32 to 82 years）. The overall survival （OS）, disease-free survival （DFS） and local control （LC） rates were calculated by Kaplan-Meier method and the difference was compared using Log-rank test. The treatment related toxieities were evaluated according to Radiotherapy Oncology Group （RTOG） criteria. Results With a median follow-up time of 34 months and following rate of 92. 2% , the 3-year OS, DFS and LC rates were 73.4%, 70. 4% and 91. 3%, respectively. The 3-year OS rate was 66. 9% for patients with tumor diameter 1〉4 cm and 86.4% for those with tumor diameter 〈4 cm （X^2 =6. 29,P =0. 012）. The incidences of grade 1 and grade 2 acute toxicities of the lower gastrointestinal tract and the genitourinary system were 40. 0% ,45.0% and 19. 9% ,4. 4%, retrospectively. There were no grade 3 or more acute toxicities. The incidence of grades 3 or 4 late toxicities of the lower gastrointestinal tract was 4. 9%. Conclusions CT-based three-dimensional external beam and 192 Ir intracavity radiotherapy combined with concurrent chemotherapy can achieve good therapeutic effects for locally advanced cervical cancer. The acute and late toxieities are significantly reduced compared with historic controls as a result of incorporation of 3DCRT technique.