组织间放疗与传统腔内放疗治疗宫颈癌的前瞻性临床对照研究

A prospective clinical controlled study on interstitial radiotherapy and traditional intracavitary brachytherapy for cerical cancer

目的:观察组织间插植腔内后装近距离放疗与传统腔内宫腔管和双侧阴道穹窿管后装近距离放疗治疗宫颈癌的临床疗效和毒副作用。方法:2011年3月—2012年9月于本院首诊的60例宫颈癌患者,随机分为实验组和对照组各30例,两组均采用同期单药化疗,给予顺铂20 mg/m^2或卡铂(AUC2),每周1次,共6次。同时两组均采用联合常规分割外照射放疗,1.8～2 Gy/次、1次/d,5次/周,预防剂量46～50 Gy。在此基础上对照组采用传统腔内宫腔管和双侧阴道穹窿管后装近距离放疗,实验组采用组织间插植腔内后装近距离放疗。放化疗过程中每周查血常规1次,定期检查肝肾功能,放疗1次/周,连续5周,疗程结束1个月内复查盆腔MRI或彩超。结果:实验组总有效率为100%,对照组为86.7%,两组比较有统计学意义(P<0.05)。实验组1、2和4年生存率分别为93.3%、90.0%和86.7%,对照组1、2和4年生存率分别为86.6%、80.0%和73.3%,两组生存率比较无统计学差异(P>0.05)。两组均发生不同程度的白细胞、血红蛋白、血小板和中性粒细胞降低以及急性放射性肠炎和急性放射性膀胱炎等毒副作用,但两组近期毒副作用无统计学差异(P>0.05)。两组均发生不同程度的晚期放射性直肠炎和晚期放射性膀胱炎,两组比较无统计学差异(P>0.05)。两组放化疗失败例数无统计学差异(P>0.05)。结论:组织间插植腔内后装近距离放疗治疗宫颈癌临床疗效好,未增加安全隐患,可在临床中使用。

Objective:To compare the difference in clinical therapeutic effects and side effects between interstitial radiotherapy and traditional intracavitary brachytherapy for cerical cancer. Methods:From March 2011 to September 2012,60 patients with cervical cancer were treated by concurrent chemoradiotherapy and interstitial radiotherapy or traditional intracavitary brachytherapy. 30 cases in the observation group were treated with single-agent chemotherapy combined with conventional external beam radiotherapy and intervented after brachytherapy, while 30 cases in the control group were given single-agent chemotherapy combined with conventional external beam irradiation and conventional post-brachytherapy. The single-agent chemotherapy was cisplatin 20 m/m^2 or carboplatin(AUC2) once a week for a total of 6 times. The radiotherapy was performed with CT or X-ray simulator. 3-dimensional conformal radiotherapy plans were prepared under treatment planning system(TPS). External beam radiotherapy was performed using conventional radiotherapy, 1.8 ～2 Gy/time, 1 time/d, 5 times/week, the prevention dose was 46 ～50 Gy. In the experimental group, intra-articular intercalary implantation was performed, while in the control group, the conventional intraluminal uterine canal and bilateral vaginal vault canal were installed after brachytherapy. Results : In the experimental group, 23 cases(76.7%) were completely relieved, 7 cases(23. 3%) partially relieved and the total effective rate was 100%. In the control group, 16 cases were complete relieved(53.3%), 12 cases(40.0%) partial relieved, 1 case stable disease, 1 cases progressive disease and the total effective rate was 86.7% Compared with the control group, the total effective rate in the the observation group were higher(χ~2=4. 286,P=0.038). The 1, 2 and 4-year survival rates in the experimental group were 93.3%(28/30), 90.0%(27/30) and 86.7%(26/30), respectively, and in the control group were 86.6%(26/30), 80.0%(24/30) and 73.3%(22/30). No significant difference was found between the two groups(P>0.05). Both groups had different degrees of leukopenia, hemoglobin decreased thrombocytopenia, neutropenia, acute radiation enteritis and acute radiation cystitis and other side effects, but 2 groups had no significant difference in side effects(P > 0.05). Both groups had different degrees of advanced radiological proctitis and advanced cystitis, there was no significant difference between 2 groups(P> 0.05). There was no significant difference in the number of failed radiotherapy and chemotherapy between 2 groups(P >0.05). Conclusion:Therapeutic effects of concurrent chemoradiotherapy and interstitial radiotherapy for cervical cancer are both good and interstitial radiotherapy needs more clinical research.