子宫移位宫颈癌盆腔四野外照射采用两种挡铅治疗方式的疗效比较

Comparison on efficacy of two kinds of lead brick treatment modalities in the four-field whole pelvic irradiation for cervical cancer with uterus excursion

目的探讨盆腔四野外照射时采用沿子宫中轴平面挡铅法治疗子宫移位宫颈癌患者的疗效和安全性。方法2009年1月至2013年3月广西壮族自治区南溪山医院收治ⅡB~ⅣA期的中晚期子宫颈癌初治患者108例,行同期放化疗。放疗采用盆腔外照射加192Ir高剂量率腔内后装治疗,化疗采用PF方案（顺铂＋5-FU）。当外照射盆腔平面中心剂量达34~40 Gy/17~20 f时改行盆腔四野外照射,在模拟机下定位并测量子宫移位程度;将发生子宫移位的70例患者随机分为对照组（n=35）和观察组（n=35）,对照组采用沿盆腔中央挡铅法,观察组采用沿子宫中轴平面挡铅法,均追加宫旁剂量15~20Gy/8~10 f。评价两组患者的近期疗效、生存率、局部复发率及毒副反应。结果观察组和对照组的完全缓解率分别为94.29%、74.29%,局部复发率分别为5.71%、22.86%,差异均有统计学意义（P〈0.05）。观察组和对照组患者的1、2年生存率分别为94.29%、82.86%和85.71%、71.43%,差异无统计学意义（P〉0.05）。两组的毒副反应主要为骨髓抑制、胃肠道反应、放射性膀胱炎和放射性直肠炎,多为1~2级,差异无统计学意义（P〉0.05）。结论沿子宫中轴平面挡铅法可以减少剂量学＂冷点＂,弥补宫旁低剂量区的弊端,提高了因子宫移位治疗时造成的子宫旁低剂量,可明显提高肿瘤的完全缓解率及近期生存率,降低肿瘤的局部复发率。

Objective To investigate the efficacy and safety of the whole pelvic four-field irradiation therapy for middle and advanced-stage cervical cancer with uterus excursion. Methods From Jan. 2009 to Mar. 2013,108 patients pathologically diagnosed as ⅡB-ⅣA cervical cancer received concurrent chemo-radiotherapy. When patients received the whole pelvic irradiation to 34-40 Gy /17-20 f,they were measured distance interrelations between uterine axis（ in the A point section of uterus） under the simulator. Seventy cervical cancer patients with uterus excursion were divided randomly into observation group（ 35 patients） and control group（ 35 patients）. Patients in the observation group used with lead brick along with the uterine central axis in the four-field whole pelvic irradiation in conventional fractionation. Patients in the control group used with lead brick along with the pelvic central in the four-field whole pelvic irradiation in conventional fractionation. They all received 15-20 Gy /8-10 f,respectively. The short-term efficacy,survival rate,local recurrence rate and toxicity were observed in two groups. Results The complete remission rate and recurrence rate in observation group and control group were 94. 29% vs. 74. 29%,5. 71% vs. 22. 86%,respectively,with significant statistically differences（ P〈0. 05）. The 1-,2-year survival rate of patients in observation group and control group were 94. 29%,82. 86% and 85. 71%,71. 43%,respectively. There were no significant statistically differences in two groups（ P〉0. 05）. The major toxicity was myelosuppression,gastrointestinal tract,radiation cystitis and radiation proctitis. There were no significant statistical differences for the incidence of toxicity in two groups（ P〉0. 05）. Conclusion It is suggested that four-field whole pelvic irradiation which used lead brick along with the uterine central axis for cervical cancer with uterus excursion can decrease the dosage＂cold point＂and improve the complete remission rate,as well as reduce the local recurrence rate.