局部晚期宫颈癌三维CT引导下加速超分割后装治疗临床观察

3D CT-guided accelerated hyperfractioned brachytherapy treated for locally advanced cervical carcinoma

目的：探讨CT引导下加速超分割三维后装放疗结合体外照射治疗局部晚期宫颈癌的临床疗效及合并症。方法：选取200708—28—2010—0809中山大学肿瘤防治中心放疗科46例初治局部晚期宫颈癌患者，体外照射采用四野盒式照射，20Gy后开始CT引导下的三维后装放疗，采用组织间插植结合腔内放疗，高危靶体积（highriskeliniealtagetvolume，HRCTV）D90处方剂量5Gy／次，2次／d，4d完成，继续后续的体外照射。结果：HRCTVD90为79．05Gy，膀胱D2ec为80．85Gy．直肠D2ce为65．05Gy，乙状结肠D2ec为65．80Gy。放疗结束后1～3个月肿瘤完全缓解率为93．48％（43／46），3年局部控制率为86．96％（40／46），3年远处转移率为17．39％（8／46），3年总生存率为89．13％（41／46）。急性反应有3级肠炎1例，2级肠炎5例。慢性放疗反应主要为便血，无3级以上放疗相关的合并症。结论：三维CT引导下加速超分割后装放疗结合体外照射治疗局部晚期宫颈癌疗效确切，快捷安全，值得推广。

OBJECTIVE： To investigate the efficacy and toxicity of the 3D CT-guided accelerated hyperfractioned brachytherapy combined with external radiation treatment for locally advanced cervical carcinoma. METHODS： Forty-six cases of locally advanced cervical carcinoma patients were collected from the cancer center of Sun Yat-sen University be- tween 2007-08-28 and 2010-09-09, who were treated by the external radiation with four field technique,and 3D CT-guided interstitial and intraluminal brachytherapy followed 20 Gy external radiation. Prescribed high risk clinical target volume （HRCTV） D90 was 6 Gy per fraction, 2 times per day. There were 8 times four days during the whole brachytherapy. The external radiation continued after the brachytherapy. RESULTS： HRCTV D90 was 79. 05 Gy, Bladder D2cc was 80.85 Gy,Rectum D2cc was 65.05 Gy,Sigmoid colon D2cc was 65.80 Gy. The tumor complete response （CR） rate was 93.48%（43/46） in one to three months after the finish of radiotherapy. The 3-year local control was 86.96% （40/46）. The 3-year metastasis rate was 17.39%（8/46） and the 3-year overall survival was 89.13% （41/46）. The acute reaction included 1 case of 3-degree enteritis and 5 cases of 2-degree enteritis. The main chronic reaction was hemafecia, and no 3-degree radiation-related complication was found. CONCLUSION： The 3D CT-guided accelerated hyperfractioned brachy- therapy combined with external radiation treated for locally advanced cervical carcinoma has a good outcome, safe and rap- id treatment, and it is valuable to generalize.