术前腔内热疗联合放射治疗ⅠB2期子宫颈癌的临床研究

Preoperative intracavitary hyperthermia combined with radiotherapy for the treatment of patients with stage ⅠB2 cervical carcinoma

目的:观察利用专利技术特别制造的微波腔内辐射器进行手术前热疗联合放射治疗ⅠB2期子宫颈癌患者的近期临床疗效和毒副反应。方法:全部病例均为ⅠB2期子宫颈鳞状细胞癌患者,术前给予腔内微波热疗联合近距离放射治疗(热放组)23例与单纯术前近距离放射治疗(单放组)33例进行比较。采用192Ir源后装近距离照射,每次给予A点5Gy,每周2次,共4次;热疗采用腔内加热的方法,肿瘤表面温度达44.5℃并持续45min,共4次。全部患者在完成放射治疗的2周后接受子宫颈癌根治术和盆腔淋巴结清除术。结果:热放组与单放组局部反应率(PR)分别为91.3%和63.6%,血清鳞状上皮癌抗原(SCC-Ag)水平下降分别为87.0%和57.6%,两者差异均有统计学意义,P<0.05;直肠反应和膀胱反应在两组之间差异无统计学意义,P>0.05。结论:腔内微波热疗联合放射治疗ⅠB2期子宫颈癌可以获得较单纯放射治疗更高的局部反应率以及鳞状上皮癌抗原(SCC-Ag)明显下降,近期的毒副反应无显著增加。可以进行更深入的临床研究。

OBJECTIVE：The purpose of this study was to observe the clinical efficacy and toxicity on the patients with stage ⅠB2 cervical carcinoma treated by intracavitary hyperthermia combining with brachy-radiotherapy before surgery.METHODS： All patients were diagnosed as stage ⅠB2 cervical carcinoma.Twenty-three patients were in the group of hyperthermia combined with brachy-radiotherapy（HT＋RT）,and thirty-three patients were in the group of brachy-radiotherapy alone（RT）.The short-term efficacy and toxicity were compared between two groups.192Ir source afterloading device was used for brachy-radiotherapy treatment,point A dose was 5 Gy/f,2 times every week,and 4 times totally;Hyperthermia was performed with a special designed applicator.All patients received radical hysterectomy two weeks later.The temperature of tumor surface was 44.5 ℃ for 45 min,and 4 time totally.RESULTS： The local response rate of HT＋RT group vs RT group were 91.3% vs 63.6%（P0.05）.Reduction in the level of squamous cell carcinoma antigen（SCC-Ag） was significantly better in the HT＋RT group（87.0% vs 57.6%,P0.05）.There were no significant differences between two groups on acute reaction of rectum and bladder（P0.05）.CONCLUSION： The results of this study show that the brachy-radiotherapy efficacy can be enhanced by intracavitary hyperthermia,without increasing acute toxicity.The further study will go on.