鸦胆子油乳联合调强放疗及腔内后装治疗宫颈癌的临床观察

Clinical observation of bruceae oil emulsion combined with radiotherapy and afterloading intracavitary brachytherapy in patients with cervical cancer

目的:观察中药鸦胆子油乳配合调强放疗(IMRT)及192Ir腔内后装治疗宫颈癌的近期有效率及毒副反应。方法:68例宫颈癌患者随机分为2组,对照组34例,全程IMRT配合腔内后装治疗。研究组34例,全程鸦胆子油乳配合IMRT及腔内后装治疗。对照组采用6MV X线调强放疗给予平均剂量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:2组近期有效率分别为85.29%和88.24%,无统计学差异(P>0.05);研究组治疗后CD3+、CD4+水平较治疗前明显升高(P<0.05),对照组CD3+、CD8+水平较治疗前下降(P<0.05);两组治疗前CD3+、CD4+、CD8+和CD56+水平比较均无差异(P>0.05),研究组治疗后上述各指标均明显高于对照组治疗后水平(P<0.05);两组毒副反应比较,研究组急性放射性肠炎及血液学毒性程度均明显低于对照组(P<0.05)。结论:鸦胆子油乳可通过提高患者机体免疫功能等途径有效避免或降低放疗毒副反应的发生,增强IMRT和腔内后装对宫颈癌患者的放疗疗效。

To investigate the effect,local control rate,life quality and complications of bruceae oil e-mulsion combined with intensity modulated radiation therapy（IMRT）and 192 Ir after loading intracavitary brach thera-py in patients with cervical cancer. Methods：Sixty - eight cervical cancer patients were divided randomly into two groups,the control group（34 cases）and the observation group（34 cases）. Both groups received IMRT plus intracav-itary brachytherapy（1. 8 - 2. 2Gy per fraction,5 fractions per week,with an average dose of 54. 5Gy）. Intracavitary brach therapy was to a total dose of 24 - 30Gy at 6Gy per fraction once a week after the dose of IMRT reached 30Gy. The observation group received 30ml of bruceae oil emulsion once a day for 21 days. Results：The effective rates of two groups were 85. 29% and 88. 24% and there was no difference in the two groups（P ﹥ 0. 05）. After treatment,the level of CD3 ＋ ,CD4 ＋ was obviously increased in the observation group（P ﹤ 0. 05）,while in the control group,the lev-el of CD3 ＋ ,CD8 ＋ was obviously decreased after treatment（ P ﹤ 0. 05）. The level of CD3 ＋ ,CD4 ＋ ,CD8 ＋ and CD56 ＋ before treatment in two groups were not significantly different（P ﹥ 0. 05）,after treatment,the level of CD3 ＋ , CD4 ＋ ,CD8 ＋ and CD56 ＋ in the observation group were higher than those in the control group（P ﹤ 0. 05）. The toxic effects were compared in two groups,the acute radiation enteritis and hematology toxic in the observation group were obviously lower than those in the control group（P ﹤ 0. 05）. Conclusion：Bruceae oil emulsion could enhance the sen-sitivity of cervical cancer cells to IMRT and intracavitary brachytherapy through improving the cell immunologic func-tion and avoiding or decreasing side effect,improve the time and quality.