^(192)Ir后装体外放射治疗Ⅱ、Ⅲ期子宫颈癌123例分析

The effects of ^(192)Ir afterloading brachytherapy combined with external beam radiotherapy on 123 cases with stage Ⅱor Ⅲ cervical cancer

目的:评价192Ir高剂量率腔内与敷贴后装近距离放疗配合直线加速器体外照射治疗Ⅱ、Ⅲ期子宫颈癌的疗效。方法:123例经病理证实的子宫颈癌患者,采用192Ir高剂量率腔内加敷贴近距离放疗配合外照射,首先全盆腔前-后野外照射,每次1.8～2 Gy,5次/周,盆腔平面中心剂量30～32 Gy/3～3.5周完成,然后盆腔中间挡铅3 cm,子宫旁剂量追加20～24 Gy/2.5～3周;同时采用近距离放疗,腔内18～24 Gy/3～4次/3～3.5周,敷贴12～18 Gy/2～3次/2～3周,总剂量30～42 Gy/5～6.5周(A点)。结果:123例随访均满5年,5年生存率为62.6%,Ⅱ、Ⅲ期5年生存率分别为68%和45.8%。RTOG/EROTC≥2级放射性直肠损伤22例,膀胱损伤8例;晚期放射性直肠、乙状结肠损伤40例,膀胱损伤为10例,直肠阴道瘘2例。结论:192Ir高剂量率腔内加敷贴后装近距离放疗配合体外照射治疗子宫颈癌疗效肯定,应用方便,晚期直肠损伤发生率稍高,但总体上放射性损伤可以接受,是安全的近距离治疗模式。

Objective：To evaluate the curative effects of 192Ir afterloading brachytherapy combined with external beam radiation therapy（EBRT） in treatment of stage Ⅱor Ⅲ cervical carcinoma. Methods：One hundred twenty-three patients with stage Ⅱ～Ⅲ（FIGO）cervical carcinoma confirmed by pathology were treated with HDR 192Ir afterloading brachytherapy combined with EBRT.The front and rear pelvic cavity was irradiated at the dose of 1.8 to 2 Gy everytime,five times per week.Pelvic plane center was treated with the dose of 30 to 32 Gy for 3 to 3.5 weeks.The 3 cms lead was placed among pelvic cavity,the dose of 20 to 24 Gy for 2.5 to 3.5 weeks was added to near the uterus,and brachytherapy was employed with the dose of 18 to 24 Gy for 3 to 4 times and lasting 2.5 to 3.5 weeks.The dose of 12 to 18 Gy for 2 to 3 times and lasting 2.5 to 3.5 weeks was applied.The total doses of brachytherapy were 30 to 42 Gy for 5 to 6.5 weeks（point A）. Results：All patients were followed up over 5 years,the survival rates were 62.6%.The 5-year survival rates of stage Ⅱand stage Ⅲ were 68% and 45.8%,respectively.When RTOG/EROTC was more than or equal to 2,the injury incidence of rectum,bladder and rectosigmoid were 22 patients,8 patients and 40 patients,respectively.The incidence of rectovaginal fistula was 2 patients. Conclusions：The curative effects of stage Ⅱor Ⅲ cervical carcinoma treated with 192Ir afterloading brachytherapy combined with EBRT are good,convenient and high incidence of rectum injury.The scheme of near distance treatment as a whole is safe.