术后调强放疗对早中期宫颈癌有效性与安全性分析

Efficacy and Safety of Postoperative Intensity-modulated Radiotherapy for Early and Middle Stage Cervical Cancer

目的:探讨术后调强放疗对早中期宫颈癌的有效性与安全性。方法:选取我院2014年1月至2016年12月206例行手术治疗的Ⅰ～Ⅱa期宫颈癌患者作为研究对象,采用随机数字表法将患者分为观察组和对照组,每组各103例,分别于术后行调强放疗、常规放疗,根据具体情况决定是否进行同步化疗。比较两组患者疗效、并发症及生活质量评估量表(FACT-Cx)生活质量评分。结果:观察组全部患者计划靶区的平均照射剂量为(45. 9±0. 5) Gy,照射体积百分比(V45)为(94. 9±1. 2)%。两组患者治疗总有效率分别为97. 1%、92. 2%,术后复发率分别为1. 9%、3. 9%,两组比较差异均无统计学意义(P> 0. 05)。两组患者无一例死亡。全部患者均未发生Ⅳ级急性放射性肠炎与急性放射性膀胱炎。观察组患者急性放射性肠炎与急性放射性膀胱炎发生情况优于对照组,差异均有统计学意义(P <0. 05)。放疗结束时两组患者的FACT-Cx总分较放疗前降低,且观察组FACT-Cx总分高于对照组,比放疗前的降低值低于对照组,差异均有统计学意义(P <0. 05)。放疗后1年,两组患者的FACT-Cx总分较放疗前升高,且观察组的总分及放疗前的升高值均高于对照组,差异均有统计学意义(P <0. 05)。结论:术后调强放疗与常规放疗对早中期宫颈癌均有较理想的近、远期疗效,与常规放疗相比,术后调强放疗能降低急性放射性肠炎与急性放射性膀胱炎的发生风险,提高生活质量。

Objective To investigate the efficacy and safety of postoperative intensity-modulated radiotherapy for early and middle stage cervical cancer. Methods ： 206 patients with early and middle stage cervical cancer in our hospital from January 2014 to December 2016 were selected as subjects for the study, and the patients were divided into the observation group and the control group by random number table method, 103 cases in each group. Patients in the observation group and the control group were given postoperative intensity-modulated radiotherapy and routine radiotherapy respectively,and then they could be given concurrent chemotherapy according to state of illness. The efficacy, complications and FACT-Cx quality of life score were compared between the two groups. Results ：The average dose of planning target volume in the observation group was（45.9±0.5）Gy, and V 45 was （94.9±1.2）%.The total effective rate in the observation group and the control group were 97.1% and 92.2% respectively, and the recurrence rate were 1.9% and 3.9% respectively. There was no statistical significance of the difference between the two groups （ P〉 0.05）.None of the patients died. There was no case occurred grade Ⅳ acute radiation enteritis and cystitis. The occurrence of acute radiation enteritis and acute radiation cystitis in the observation group were better than that in the control group （ P〈 0.05）. The total score of FACT-Cx in the two groups decreased immediately after radiotherapy,and the total score of FACT-Cx in the observation group was higher than that in the control group, and the reduced value was lower than that in the control group （ P〈 0.05）.The total score of FACT-Cx increase at 1 year after radiotherapy, and the total score and elevated value in the observation group were higher than those in the control group, and the difference was statistical significance （ P〈 0.05）. Conclusion ：Postoperative intensity-modulated radiotherapy and conventional radiotherapy all have ideal short-term and long-term effects on early and middle stage cervical cancer. Compared with conventional radiotherapy,postoperative intensity-modulated radiotherapy can significantly reduce the risk of acute radiation enteritis and acute radiation cystitis, improve the quality of life.