^(252)锎中子腔内后装治疗子宫颈癌的临床观察

The preliminary report of cervical cancer treated with californium-252 neutron after loading intracavitary radiotherapy

目的 观察2 52 锎中子腔内后装治疗宫颈癌的近期疗效以及并发症的发生情况 ,对该治疗方案进行初步评价。方法 选择 5 1例未曾接受过任何治疗的临床分期为Ⅱ、Ⅲ期的宫颈癌患者作为研究对象 ,其中Ⅱa期 8例 ,Ⅱb期 31例 ,Ⅲa期 8例 ,Ⅲb期 4例。治疗方案 :2 52 锎中子腔内后装治疗 ,宫旁A点 ,10～ 12Gy/次 ,1次 /周 ,共进行 3～ 4次 ,该治疗间歇穿插全盆腔外照射 ,前后对穿野 ,2 0 0cGy/次 ,4次 /周 ,外照射 2 0～ 30Gy后 ,盆腔野中央屏蔽挡铅 4cm ,2 0 0cGy/次 ,4次 /周 ,使总剂量达到 4 5～ 5 0Gy ,总疗程约 5～ 6周。结果 5 1例患者均随访 2年 ,肿瘤的完全消退时间平均 2 5d ,2年局部控制率为 10 0 % ,2年生存率为 92 %。其中 ,临床分期Ⅱa期者 2年生存率为 8例中 8例 ,Ⅱb期中97% (30 / 31) ,Ⅲa期为 8例中 6例 ,Ⅲb期为 4例中 3例 ;肿瘤直径≥ 4cm者为 94 % (30 / 32 ) ,<4cm者为 19例中 17例。放射性膀胱炎、放射性直肠炎发生率均为 2 % (1/ 5 1)。结论 2 52 锎中子腔内后装治疗临床分期Ⅱ、Ⅲ期的宫颈癌具有局部控制率高、治疗时间短、患者放射治疗后并发症发生率低等特点 。

Objective To observe the therapeutic effectiveness and complications of californium 252 ( 252 Cf) brachytherapy in cervical cancer Methods Fifty one cases of cervical cancer were diagnosed according to the standard of the International Federation of Gynecology and Obstetrics (FIGO), Ⅱa:8 cases,Ⅱb:31 cases,Ⅲa:8 cases, Ⅲb:4 cases Treatment schedule: 252 Cf after loading brachytherapy, 10～12 Gy/fraction/week, the total dose of reference point A was 36～40 Gy in three to four implant sessions In the second day after 252 Cf therapy, the whole pelvis was treated with 6 MV X ray external beam radiotherapy, 200 cGy per fraction, 4 times per week The total dose of external beam radiotherapy was 40 to 50 Gy (the middle of pelvis was blocked at width of 4 cm after 20～30 Gy), then the total dose of reference point B was 50～55 Gy;the total treatment time was 5～ 6 weeks Results The average time of complete tumor regression was 25 days, the local control rate of 2 year was 100%, the total 2 year survival rate was 92%, i e ,Ⅱa: 8/8 cases,Ⅱb: 30/31 cases (97%),Ⅲa: 6/8 cases, Ⅲb: 3/4 cases; the late radiation complications of bladder and rectum was 2% respectively during these 2 years Conclusions It is concluded that combined 252 Cf brachytherapy and high energy X ray external beam radiotherapy may be safe and effective in the managment of cervical cancer 252 Cf has advantages of high local control rate; rapidly regression of bulky tumors and low grade radiation complications