体外三维适形调强放疗联合近距离腔内放疗对Ⅱb~Ⅲb期子宫颈残端癌的疗效

Efficacy of three-dimensional conformal intensity modulated radiotherapy combined with brachytherapy in patients with Ⅱb-Ⅲb cervical stump carcinoma

目的探讨体外三维适形调强放疗联合近距离腔内放疗对Ⅱb~Ⅲb期子宫颈残端癌的治疗效果。方法选取2008年1月—2013年10月收治的50例Ⅱb~Ⅲb期子宫颈残端癌病人,随机分为研究组和对照组各25例。对照组采用体外常规放疗联合近距离腔内治疗,研究组采用体外三维适形调强放疗联合近距离腔内放疗。观察两组病人术后近期疗效及远期并发症的相关指标,采用Kaplan-Meier法进行生存分析,Log-rank法比较生存时间。结果两组间治疗有效率、1年内复发率差异无统计学意义（P〉0.05）。研究组平均复发时间长于对照组（P〈0.05）,Ⅰ~Ⅱ级急性直肠反应、Ⅰ级急性膀胱反应和Ⅱ级晚期膀胱反应的发生率均显著低于对照组（P〈0.05）。两组复发生存曲线差异有统计学意义（χ~2=5.393,P=0.020）。结论体外三维适形调强放疗联合近距离腔内放疗与体外常规放疗联合近距离腔内治疗相比,对Ⅱb~Ⅲb期子宫颈残端癌疗效无明显差异,但其并发症减少,短期复发率低,生存率较高,仍具有较大优势。

Objective To investigate the effect of three-dimensional conformal intensity modulated radiotherapy combined with brachytherapy in the treatment of Ⅱb-Ⅲb cervical stump carcinoma. Methods Fifty patients with cervical stump Ⅱb-Ⅲb cancer who were treated in our hospital from January 2008 to October 2013 were randomly selected, thepatients were divided into treatment group （25 cases） and control group （25 cases）. The controls received conventional radiotherapy combined with a close group of endovascular treatment, while the treatment group was given three-dimensional conformal intensity modulated radiotherapy combined with brachytherapy. The indexes of recent effects and long-term complications after surgery in two groups were observed. The survival times of the two groups were compared with Kaplan- Meier and Log-rank test. Results The total clinical efficiency and tumor recurrence rate of the treatment group and control group did not significantly differ （P〉0.05）. The median recurrence time of the treatment group were significantly higher than that of control group （P〈0.05）. The incidences of Ⅰ-Ⅱ grade acute rectal reaction, Ⅰ grade acute bladder reaction of short-term complications, andⅡ grade advanced bladder reactions of long-term complications were significantly lower than that of control group （P〈0.05）. The survival curve of recurrence were statistically different （χ2=5.393, P=0.020） between the two groups. Conclusion The three-dimensional conformal intensity modulated radiotherapy combined with brachytherapy do not significantly improve the efficacy （P〉0.05） in the treatment of Ⅱb-Ⅲbb cervical stump carcinoma, but the less complications and lower tumor recurrence rate make survival rate higher.