中晚期子宫颈癌调强放疗同步化疗与常规盆腔野放疗同步化疗效果比较

Efficacy comparison between intensity modulated radiotherapy combined with chemotherapy and conventional pelvic radiotherapy combined with chemotherapy for middle and advanced cervical cancer

目的 比较中晚期子宫颈癌患者外照射行调强放疗（IMRT）及常规盆腔野放疗的疗效及不良反应.方法 2007年10月至2012年9月收治的72例原发ⅡB~ⅢB期子宫颈癌患者接受IMRT（IMRT组）,按随机数字表法抽取同期采用普通盆腔前后对穿野放疗的患者72例为对照（常规放疗组）.IMRT组采用6 MV X线7野共面照射.计划靶区（PTV）46~50 Gy,大体肿瘤靶区（GTVnd）同步加量54~60 Gy,分25~28次完成.常规放疗组全盆腔野放疗30~40 Gy后,中央挡铅4 cm,改为四野照射,加量至46~54 Gy.两组患者体外照射完成总剂量30 Gy后,予192Ir腔内照射,5~7 Gy/次,总剂量酌情给予30~45 Gy,同步顺铂（DDP）增敏化疗.结果两组近期完全缓解、部分缓解、总反应率差异均无统计学意义（均P〉0.05）.IMRT组和常规放疗组1年生存率比较差异无统计学意义[94.4%（68/72）比88.9%（64/72）,P〉0.05],3、5年生存率差异均有统计学意义[76.4%（55/72）比59.7%（43/72）,72.2%（52/72）比55.6%（40/72）,均P〈0.05].急性放疗不良反应主要为消化系统、泌尿系统、皮肤反应以及血液学毒性（骨髓抑制）,IMRT组骨髓抑制及皮肤反应发生率及程度低于常规放疗组,差异均有统计学意义（均P〈0.05）;晚期放疗不良反应主要为直肠、膀胱、皮肤反应以及血液学毒性（骨髓抑制）,IMRT组直肠、皮肤反应发生率低于常规放疗组,差异均有统计学意义（均P〈0.05）.结论 中晚期子宫颈癌患者行IMRT可提高3~5年生存率,并降低急性及晚期放疗不良反应,改善患者生命质量.

Objective To compare the efficacy and adverse reactions of intensity-modulated radiation therapy （IMRT） and conventional pelvic field radiation therapy for middle and advanced cervical cancer. Methods A total of 144 patients with stageⅡB-ⅢB cervical cancer from October 2007 to September 2012 were divided into IMRT group （72 cases）, and routine radiotherapy group （72 cases） by using random number table method. The IMRT group was exposed to the 6 MV-X line 7 field, a dose of 46-50 Gy for planning target volume （PTV）, 54-60 Gy for gross tumor volume （GTVnd） simultaneously integrated boosted, in 25-28 fractions. The central block of lead 4 cm was changed to 4 fields irradiation, adding to 46-54 Gy for the conventional group after 30-40 Gy of the whole pelvic field. The total dose for the two groups of patients was 30-45 Gy, after completed 30 Gy in vitro exposure, to the cavity irradiation, 5-7 Gy/fraction, and synchronous cisplatin （DDP） sensitization chemotherapy was done synchronously. Results The recent complete remission, partial remission, overall survival ratio of two groups were compared respectively, and the difference was not statistically significant （P 〉 0.05）. The difference in 1 year survival rate of IMRT group and routine radiotherapy group was not statistically significant （χ^2= 1.455, P〉 0.05）. The difference in 3 and 5 year survival rate was statistically significant [76.4 % （55/72） vs. 59.7 % （43/72）; 72.2 % （52/72） vs. 55.6 %（40/72）, P〈 0.05]. Acute radiotherapy major adverse reactions included the digestive system, urinary system, skin response and haematological toxicity （bone marrow suppression）. The incidence and degree of skin response in IMRT group was lower than that in routine radiotherapy group （P〈0.05）. The adverse effects of late radiotherapy were mainly rectal, bladder, skin response and hematological toxicity （bone marrow suppression）. The incidence rectal and skin response in IMRT group was lower than that in routine radiotherapy group （P〈 0.05）. Conclusion The IMRT can improve the survival rate of advanced cervical cancer patients for 3-5 years, reduce the adverse effects of acute and terminal radiotherapy, and improve the quality of life.