宫颈癌初始治疗后腹主动脉旁淋巴结转移调强放疗的临床观察

Clinical analysis of intensity modulated radiation therapy in cervical cancer patients with para-aortic lymph node metastasis after initial treatment

目的 对比单纯调强放疗（IMRT）与IMRT同步TP方案化疗治疗宫颈癌初始治疗后腹主动脉旁淋巴结（PALN）转移的疗效和不良反应.方法 选取2008年10月至2013年8月宫颈癌初始治疗后出现PALN转移的56例患者,PALN转移病灶给予放疗剂量GTV 55～60 Gy,CTV45 ～ 50 Gy,共25 ～ 30次,5～6周,接受同步放化疗（CRT组）者36例,单纯放疗（RT组）者20例.CRT组的同步化疗方案为TP方案,第1天紫杉醇135 mg/m2,顺铂60 mg/m2 2 d,21 d重复.单纯PALN转移（iPALN）患者33例,合并其他部位复发转移（niPALN）患者23例.结果 中位随访时间22.7个月（2.7 ～74.4个月）.98.2％（55/56）的患者完成了放疗,CRT组中,38.9％的患者完成化疗2～3个周期,61.1％的患者完成化疗1个周期.CRT和RT组的有效率（CR ＋PR）分别为91.7％（33/36）和85％ （17/20）（x2=0.516,P＞0.05）.两组患者的中位总生存（OS）时间为38和23个月,3年OS率分别为57.5％和32.7％ （x2 =4.059,P＜0.05）,中位无进展生存时间（PFS）为68.3和16个月,3年PFS率分别为50.4％和29.2％（x2=4.184,P＜0.05）.单纯PALN转移（iPALN）（33例）患者与合并其他部位复发转移（niPALN）患者（23例）的中位OS分别为71.2和21.4个月,3年OS率分别为53％和39.5％（x2=4.265,P＜ 0.05）.CRT和RT组出现3或4级白细胞低下的患者分别为10例（27.8％）和6例（30％）,3级消化道反应各有1例,差异均无统计学意义（x2=0.693、0.847,P＞ 0.05）.结论 IMRT同步TP化疗对PALN转移的患者近期效果和远期生存均优于单纯放疗的患者,且不良反应可耐受.

Objective To evaluate the efficacy and toxicities of intensity modulated radiation therapy （IMRT） with or without concurrent chemotherapy in the treatment of cervical cancer patients with para-aortic lymph node （PALN） metastases after initial treatment.Methods From Oct 2008 to Aug 2013,56 cervical cancer patients with PALN metastases after initial treatment,including radical resection or pelvic radiotherapy/chemoradiotherapy,were selected for analysis.The delivered radiation dose to PALN was 55-60 Gy for GTV and 45-50 Gy for CTV respectively with 25-30 fractions during 5-6 weeks.36 patients received concurrent paclitaxel （135 mg/m2） and cisplatin （60 mg/m2） chemoradiotherapy （CRT group） and 20 patients received RT alone （RT group）.Results The median follow-up time after treatment was 22.7 months （2.7 to 74.4 months）.98.2% （55/56） of patients completed RT.In CRT group,38.9% underwent concurrent TP regimen 2-3 cycles and the rest completed one cycle.The rates of CR plus PR in CRT and RT groups were 91.7% （33/36） and 85% （17/20）,respectively （x2 =0.516,P 〉0.05）.The 3-year overall survival rate in CRT group and RT group were 57.5% and 32.7% （x2 =4.059,P 〈 0.05）,and 3-year progression-free survival rates were 50.4% and 29.2% （x2 =4.184,P 〈 0.05）,respectively.TP regimen concurrent chemoradiotherapy was more effective than radiotherapy alone.The 3-year overall survival rate was 53% and 39.5% in patients with isolated PALN and nonisolated PALN,respectively （x2 =4.265,P 〈 0.05）.Grade 3 or 4 acute leukopenia was found in 10 （27.8%,CRT group） and 6 （30%,RT group） patients （x2 =0.693,P 〉 0.05）.Grade 3 gastrointestinal toxicity occurred in 1 patient each group （x2 =0.847,P 〉 0.05）.Conclusions TP regimen concurrent CRT is associated with better survival than RT alone,and the treatment toxicities could be tolerant.