体外延伸野放疗联合化疗治疗宫颈癌腹主动脉旁淋巴结转移的临床研究

Clinical Study of Extended-field Intensity Modulated Radiation Therapy Combined with Chemotherapy in Treating Cervical Carcinoma with Para-aortic Lymph Node Metastasis

目的:研究体外延伸野调强放疗联合腔内放疗及紫杉醇酯质体周方案化疗治疗中晚期宫颈癌合并腹主动脉旁淋巴结转移的临床效果及不良反应。方法:55例合并腹主动脉旁淋巴结转移的中晚期宫颈癌(Ⅱb-Ⅲb期),全部予以体外延伸野放疗联合腔内放疗及紫杉醇酯质体周方案化疗,体外延伸野调强放疗的延伸野剂量为50.4 Gy/28次/1.8 Gy/次,腹主动脉旁淋巴结加量6～8 Gy,盆腔剂量给予45 G/25 f/1.8 Gy/次,盆腔转移淋巴结宫旁加量6～8 Gy,外照射5周后加用腔内后装放疗,A点剂量6 Gy/次,4～5次,放疗期间同步紫杉醇酯质体(60 mg/m2)周方案化疗,共5周,观察患者临床疗效及毒副反应。结果:放疗后3个月复查,有效率为83.6%(46/55),临床控制率为90.9%(50/55),患者1年、3年生存率分别为78.2%(43/55)、61.8%(34/55),1年、3年无进展生存率(PFS)分别为36.4%(20/55)、63.4%(35/55)。在放疗副反应方面,所有患者均发生不同程度的骨髓抑制,≥Ⅲ度骨髓抑制发生率为36.4%(20/55),Ⅰ～Ⅱ级胃肠道反应发生率为87.3%(48/55),≥Ⅲ级胃肠道反应发生率为5.5%(3/55),Ⅰ级泌尿系统反应发生率为34.5%(19/55)。晚期Ⅰ～Ⅱ级放射性直肠炎发生率为23.6%(13/55),≥Ⅲ级放射性直肠炎发生率为5.5%(3/55),Ⅱ级放射性膀胱炎发生率为7.3%(4/55)。结论:体外延伸野调强放疗联合腔内放疗及紫杉醇酯质体周方案化疗治疗中晚期宫颈癌合并腹主动脉旁淋巴结转移,临床疗效好,毒副反应可耐受。

Objective：To study the clinical efficacy and side effects of combination of extended-field intensity modulated radiotherapy combined with intracavitary radiotherapy and paclitaxel liposomes weekly chemotherapy in the treatment of advanced cervical cancer with para-aortic lymph node metastasis.Method：A total of 55 advanced cervical cancer with para-aortic lymph node metastasis （stage Ⅱb-Ⅲb） were selected,all were treaded with extended field intensity modulated radiotherapy combined with intracavitary radiotherapy and paclitaxel liposomes weekly chemotherapy.Extension field dose was 50.4 Gy/28 times/1.8 Gy/per fraction,with boost dose of 6.0-8.0 Gy in 2.0 Gy per fraction to positive para-aortic lymph nodes.Pelvic dose was 45Gy /25 times/1.8 Gy/per fraction,with boost dose of 6.0-8.0 Gy in 2.0 Gy per fraction to pelvic lymph node metastasis.A1l patients also received a high-dose-rate intracavitary brachytherapy at the point“A”dose of 24.0-30.0 Gy in 6.0 Gy per fraction after 5 weeks of extended-field intensity modulated radiotherapy. Paclitaxel liposomes （60 mg/m2） weekly chemotherapy were administered during radiotherapy for 5 weeks.The clinical efficacy and side effects of the patients were observed.Result： After 3 months of radiotherapy,the effective rate was 83.6% （46/55） and the clinical control rate was 90.9% （50/55）.The one-year and three-year survival rates were78.2% （43/55） and 61.8% （34/55） respectively,and the one-year and three-year progression-free survival rates were 36.4% （20/55） and 63.4% （35/55）.All patients had different degrees of myelosuppression,the incidence of ≥Ⅲ degree myelosuppression was 36.4% （20/55）,the incidence of grade Ⅰ-Ⅱ gastrointestinal reaction was 87.3% （48/55） and the incidence of ≥Ⅲ grade gastrointestinal reactions was 5.5% （3/55）,grade Ⅰ urinary system reaction was 34.5% （19/55）.The incidence of advanced grade Ⅰ-Ⅱ radiation proctitis was 23.6% （13/55）,the incidence of ≥Ⅲ grade radiation proctitis was 5.5% （3/55） and the incidence of gradeⅡ radiation cystitis was 7.3% （4/55）.Conclusion： The combination of extended-field intensity modulated radiotherapy combined with intracavitary radiotherapy and paclitaxel liposomes weekly chemotherapy in the treatment of advanced cervical cancer with para-aortic lymph node metastasis had good clinical efficacy and toxic side effects can be tolerated.