三维与二维后装放疗治疗局部晚期宫颈癌临床疗效分析

Three- and two-dimensional brachytherapy for locally advanced cervical cancer

目的探讨CT引导下的192Ir三维近距离放疗与二维后装治疗局部晚期宫颈癌的临床疗效。方法 700例宫颈癌Ⅱb~Ⅲb期患者,根据放疗方法分为对照组和观察组各350例。2组患者先行45~46 Gy三维调强外照射,对明显增大的盆腔淋巴结和宫颈旁转移区域追加高度适形的三维适形外照射10~15 Gy,之后进行1次/周后装放疗,对照组采用常规二维腔内后装治疗,观察组在CT引导下采用192Ir后装机行三维腔内后装放疗,放疗期间2组均行顺铂单药化疗4~6周,在8周内完成治疗。比较2组治疗后1个月治疗有效率、靶区域覆盖指数、靶区适形指数及治疗后急性放射性肠炎、急性放射性膀胱炎发生率。结果治疗后1个月,观察组治疗有效率(68.29%)高于对照组(56.00%)(P<0.05);观察组治疗后乙状结肠D2cc、膀胱D2cc及直肠D2cc照射剂量[(69.47±1.97)、(79.19±2.64)、(68.21±2.32)Gy]均低于对照组[(73.21±2.31)、(83.19±3.58)、(72.38±2.49)Gy](P<0.05),靶区域覆盖指数(0.97±0.12)、靶区适形指数(0.93±0.12)均高于对照组(0.93±0.09、0.87±0.09)(P<0.05);观察组2、3级急性放射性膀胱炎发生率(31.71%、1.71%)及2、3、4级急性放射性肠炎发生率(24.57%、21.71%、1.14%)均低于对照组(45.71%、2.86%,28.57%、25.71%、2.00%)(P<0.05)。结论宫颈癌三维后装放疗有助于提高近期疗效,降低对周围组织的辐照剂量,不良反应发生率较低。

Objective To explore the clinical effects of three-dimensional 192Ir brachytherapy and two-dimensional brachytherapy on locally advanced cervical cancer. Methods Totally 700 patients with cervical cancer stage Ⅱb-Ⅲb were divided into control group(n=350) and observation group(n=350) according to the radiotherapy method. Both two groups received 45 to 46 Gy three-dimensional intensity modulated external irradiation, followed by brachytherapy once a week. Control group was treated with conventional two-dimensional brachytherapy. Observation group was treated with CT-guided three-dimensional 192Ir brachytherapy. The significantly enlarged pelvic lymph nodes and paracervical metastasis areas were supplemented with 10 to 15 Gy highly conformal three-dimensional external irradiation. Cisplatin single drug chemotherapy was given for 4 to 6 weeks during radiotherapy, and both groups completed 8-week treatment. The effective rate, area coverage index, the target area conformability index, and the incidences of acute radiation enteritis and cystitis after treatment were compared one month after treatment between two groups. Results The effective rate was significantly higher in observation group(68.29%) than that in control group(56.00%)(P<0.05). The doses of sigmoid colon D2 cc, bladder D2 cc and rectal D2 cc radiation were significantly lower in observation group((69.47±1.97),(79.19±2.64),(68.21±2.32) Gy) than those in control group((73.21±2.31),(83.19±3.58),(72.38±2.49) Gy)(P<0.05). The area coverage index and the target area conformability index were significantly higher in observation group(0.97±0.12, 0.93±0.12) than those in control group(0.93±0.09, 0.87±0.09)(P<0.05). The incidences of grade 2 and 3 acute radiation cystitis and grade 2, 3 and 4 acute radiation enteritis were significantly lower in observation group(31.71%, 1.71%, 24.57%, 21.71%, 1.14%) than those in control group(45.71%, 2.86%;28.57%, 25.71%, 2.00%)(P<0.05). Conclusion Three-dimensional brachytherapy could improve the short-term effect on cervical cancer, reduce the radiation dose and lower the incidence of adverse reactions.