局部晚期宫颈癌三维腔内后装放疗效果与预后

Efficacy and prognosis of three-dimensional intracavitary brachytherapy for locally advanced cervical cancer

目的观察局部晚期宫颈癌三维腔内后装放疗的效果和生存期,并对影响预后的相关因素进行初步分析。方法对63例局部晚期宫颈癌采用EBRT加三维腔内后装放疗,联合同步或序贯化疗。盆腔外照射放疗的剂量为50~60 Gy,在5~6周内完成,加三维腔内后装放疗35~45 Gy,每周1~2次,每次5~7 Gy。观察近期疗效、无进展生存期(PFS)、总生存情况及毒副反应,并分析影响生存的相关因素。结果21例完全缓解(CR),29例部分缓解(PR),6例稳定(SD)或进展(PD),7例原发病灶缩小或稳定,但发现区域淋巴结转移或远处转移。客观缓解率(CR+PR)为79.36%,中位生存时间为40.61个月,1年生存率为93.1%,3年生存率为82.2%,中位PFS为33.31个月。除了肿瘤分期、HR-CTV放疗吸收剂量对生存产生了显著影响外,无数据提示其余因素对生存有影响。患者2~3级急性期毒性反应的发生率为11.1%,2~3级晚期毒性反应发生率为12.6%。结论三维腔内后装放疗在局部晚期宫颈癌治疗中效果好,除临床分期为独立的预后影响因素外,剂量参数与预后存在一定相关性。

Objective To observe the curative effect of three-dimensional intracavitary brachytherapy for locally advanced cervical cancer,and to preliminarily analyze the related factors affecting the prognosis.Methods Sixty-three cases of locally advanced cervical cancer were treated with EBRT plus three-dimensional intracavitary radiotherapy combined with concurrent or sequential chemotherapy.The dosage of pelvic external irradiation was 50 to 60 Gy,which was completed within 5 to 6 weeks.The three-dimensional intracavitary post-irradiation was added 1 to 2 times a week,5 to 7 Gy each time.The short-term efficacy,progression-free survival,overall survival,related factors affecting survival and toxic side effects were analyzed.Results CR was found in 21 cases,PR in 29 cases,SD or PD in 6 cases,and primary lesions were reduced or stable in 7 cases,but regional lymph node metastasis or distant metastasis were found.The objective remission rate(CR+PR)was 79.36%.The median survival time was 40.61 months,the one-year survival rate was 93.1%,the three-year survival rate was 82.2%,and the median PFS was 33.31 months.Except that tumor stage and HR-CTV radiation dose had effect on survival,the other factors had no effect on survival.The incidence of grade 2 to 3 acute toxicity was 11.1%.The incidence of late toxicity in grade 2 to 3 was 12.6%.Conclusion Three-dimensional intracavitary brachytherapy has a good effect in the treatment of locally advanced cervical cancer.In addition to clinical staging as an independent prognostic factor,there is a certain correlation between dose parameters and prognosis and toxicity.