中晚期宫颈癌同步推量调强放疗的临床研究

Clinical study on simultaneous modulated accelerated radiotherapy for advanced cervical cancer

目的研究同步推量调强放疗(SMART)及调强放疗治疗中晚期宫颈癌的临床疗效及不良反应。方法选取2011年4月至2017年4月在我院住院治疗的60例中晚期宫颈癌患者,采用分层区组随机化分组方法,分为试验组30例、对照组30例。两组患者体外放疗同时给予腔内后装放疗及同步化疗。试验组给予SMART,对照组给予调强放疗,两组95%计划靶区(PTV)剂量为50.4 Gy/28 F,试验组肿瘤同步推量靶区剂量为64.4 Gy/28 F。比较两组患者疾病进展情况、生存情况及不良反应。结果放疗结束时,试验组完全缓解(CR)23例,部分缓解(PR)4例,病情稳定(SD)2例,疾病进展(PD)1例;对照组CR 22例,PR 3例,SD 3例,PD 2例;两组患者总体有效率比较,试验组稍高于对照组(90.0%∶83.3%),但差异无统计学意义(χ^2=0.144,P=0.704)。3个月后复查,试验组CR 28例,PR 1例,PD 1例;对照组CR 22例,PR 2例,SD 3例,PD 3例;两组患者总体有效率比较,试验组稍高于对照组(96.7%∶80.0%),但差异无统计学意义(χ^2=2.588,P=0.108)。试验组、对照组患者的中位生存时间分别为43个月、38个月,差异有统计学意义(χ^2=7.087,P=0.008),其中两组患者1年生存率分别为96.6%、85.7%,3年生存率分别为86.2%、60.7%。在放疗不良反应方面,两组患者消化道反应(66.7%∶63.3%, χ^2=0.073,P=0.787)、泌尿系统反应(33.3%∶30.0%, χ^2=0.077,P=0.781)及骨髓抑制发生率(83.3%∶86.7%, χ^2=0.000,P=1.000)比较,差异均无统计学意义。结论中晚期宫颈癌患者SMART疗效优于调强放疗,不良反应可耐受,值得临床推广。

Objective To study the clinical efficiency and adverse reactions of simultaneous modulated accelerated radiotherapy (SMART)and intensity-modulated radiation therapy (IMRT)in advanced cervical cancer. Methods Sixty patients with advanced cervical cancer were collected from April 2011 to April 2017 in our hospital. The 60 patients were randomly divided into experimental group (30 cases)and control group (30 cases)by using stratified randomization method. The two groups were given intracavitary irradiation and concur-rent chemotherapy. The patients in experimental group were treated with SMART and the patients in control group were treated with IMRT. 95% planned target volume was 50. 4 Gy/ 28 F in the two groups and the dose for IMRT with simultaneous integrated boost was 64. 4 Gy/ 28 F to the planning target volume. Disease progres-sion,survival time and adverse reactions of the two groups were compared. Results At the end of radiothe-rapy,the experimental group had 23 patients with complete response (CR),4 patients with partial response (PR),2 patients with unaltered stable disease (SD),1 patient with progressive disease (PD),and the control group had 22 patients with CR,3 patients with PR,3 patients with SD,2 patients with PD. The overall effi-ciency of the experimental group was slightly higher than that of the control group (90. 0% vs. 83. 3%),but the difference was not statistically significant (χ2 = 0. 144,P = 0. 704). After 3 months of radiotherapy,the experimental group had 28 patients with CR,1 patient with PR,1 patient with PD,and the control group had 22 patients with CR,2 patients with PR,3 patients with SD,3 patients with PD. The overall efficiency of the experimental group (96. 7%)was higher than that of the control group (96. 7% vs. 80. 0%),but the diffe-rence was not statistically significant (χ2 = 2. 588,P = 0. 108). The median overall survival time of the experi-mental group and control group were 43 months and 38 months,and the difference was statistically significant (χ2 = 7. 087,P = 0. 008). The 1-year survival rates of the two groups were 96. 6% and 85. 7%,and the 3-year survival rates were 86. 2% and 60. 7%,respectively. There were no significant differences in the inci-dences of gastrointestinal reaction (66. 7% vs. 63. 3%,χ2 = 0. 073,P = 0. 787),urinary system reaction (33. 3% vs. 30. 0%,χ2 = 0. 077,P = 0. 781)and bone marrow suppression (83. 3% vs. 86. 7%,χ2 =0. 000,P = 1. 000)between the two groups. Conclusion The efficiency of advanced cervical cancer patient treated with SMART is better than IMRT,and the adverse reactions are tolerable,which is worthy of clinical promotion.