鸦胆子油乳增强宫颈癌放疗疗效的临床研究

Bruceolic Oil Emulsion Enhances the Effect of Radiotherapy in Patients with Cervical Carcinoma

目的：观察中药鸦胆子油乳联合调强放疗（IMRT）及”Ir腔内后装治疗宫颈癌的临床疗效。方法：68例宫颈癌患者随机分为2组，对照组34例，采用6MVX线调强放疗，平均剂量54．5Gy，1．8～2．2Gy／次，每周5次，放疗30Gy后开始作腔内后装治疗，后装照射共给5次，每周1次，每次6Gy，治疗当日不进行外照射。研究组34例，在对照组治疗基础上另加用鸦胆子油乳注射液30mL加入0．9％氯化钠注射液250mL中静脉滴注，每天1次，连续使用21d。结果：研究组治疗后KPS评分较治疗前升高（P〈0．05），对照组治疗后KPS评分较治疗前降低（P〈0．05）。研究组和对照组治疗前KPS评分比较无差异（P〉0．05），治疗后研究组KPS评分高于对照组（P〈0．05）；2组近期有效率为91．2％和88．2％（P〉0．05）；1年控制率为70．6％和79．4％（P〈0．05），2年控制率为64．7％和76．5％（P〈0．05）；1年生存率为82．4％和94．1％（P〈0．05），2年生存率为79．4％和91．2％（P〈0．05）；研究组治疗后血液流变学中的8项指标均较治疗前明显下降（P〈0．05），对照组治疗前后8项指标元明显变化（P〉0．05）。研究组治疗后血液流变学中的8项指标均明显低于对照组治疗后水平（P〈0．05）。赔论：鸦胆子油乳可通过改善患者血液系统微环境，增加氧的供给来提高宫颈癌细胞对IMRT和腔内后装放疗的敏感性，增强宫颈癌放疔疗效，并进一步提高了生存期和生存质量。

Objective To investigate the therapeutic effects of bruceolic oil emulsion injection,combined with intensity mod- ulated radiation therapy（IMRT） and 192Ir intracavitary afterloading therapy in patients with cervieal carcinoma. Methods Sixty-eight patients with cervical carcinoma were randomly divided into control group and observation group（ n = 34 ）. The patients in control group were given IMRT with a mean dose of 54.5 Gy（ 1.8 ~ 2.2 Gy per fraction,5 fractions per week） by 6 MV X-ray, and then the intraeavitary afterloading therapy were given for 5 times （6 Gy per fraction, once a week） when the dose of IMRT reached 30 Gy. The patients in observation group were additionally given 30 mL bruceolic oil emulsion in- jection diluted in 250 mL sodium chloride solution with intravenous drip daily for 21 days. Results The Karnofsky scores （KPS） of patiens had no significant difference between two groups before treatment（P 〉 0.05） ,but KPS was significantly increased and decreased in observation group and control group after treatment （ both P 〈 0.05）, respectively. The KPS of observation group was significantly higher than that of control group after treatment （ P 〈 0.05 ）. The short term response rates of observation group and contol group were 91.2% and 88.2% ,meanwhile,the control rates of 1 year were 70.6% and 79.4%, the control rates of 2 years were 64.7% and 76.5%, the survival rates of 1 year were 82.4% and 94.1%, re- spectively. The above indexes were all significantly different between two groups（ all P 〈 0.05 ）. Total 8 indexes of hemorhe- ology had improved in observation group and significantly lower than those of control with treatment（P 〈 0.05 ）, but which had no significant change in control group before and after treatment（ P 〉 0.05 ）. Conclusion Bruceolic oil emulsion could enhance the sensitization of cervix carcinoma cells to IMRT and intracavitary afterloading therapy through improving the mi- cro environment of hematological system and increasing oxygen supply, and then improve the life time and quality.