超声造影检查对中晚期宫颈癌放化疗患者疗效的评估

Evaluation of contrast-enhanced ultrasonography in the treatment of advanced cervical cancer with radiotherapy and chemotherapy

目的研究超声造影(即对比增强超声,CEUS)检查在中晚期宫颈癌放化疗患者疗效评估中的应用价值。方法选取2016年10月至2018年7月中晚期宫颈癌患者76例作为研究对象,所有患者均采用化疗联合三维适形放疗治疗,统计分析治疗效果,根据治疗效果分为治疗有效组(n=61)和治疗无效组(n=15)。分别于治疗前及治疗4个化疗周期后对两组行CEUS检查,以病理诊断作为金标准,分析CEUS诊断肿瘤灭活的准确度,并对比两组CEUS参数。结果本组76例中晚期宫颈癌患者,治疗4个化疗周期后,完全缓解36例,部分缓解25例,疾病稳定10例,疾病进展5例,有效率为80. 26%(61/76)。4个化疗周期后肿瘤直径较治疗前缩小,差异有统计学意义[(13. 72±3. 21) mm vs (38. 19±4. 32) mm,t=39. 636,P=0. 000]。本组76例患者CEUS共检出86个肿瘤病灶,CEUS检查诊断准确度为91. 86%(79/86)。4个化疗周期后,治疗有效组CEUS参数上升时间(RT)、峰值强度(PI)、曲线下面积(AUC)值均较治疗前降低,平均通道时间(MTT)、达峰时间(TP)较治疗前升高,差异有统计学意义(P<0. 05);治疗无效组各值与治疗前对比无统计学差异(P>0. 05)。4个化疗周期后,治疗有效组RT、PI、AUC值均低于治疗无效组,MTT、TP值均高于治疗无效组(P<0. 05,P<0. 01)。结论中晚期宫颈癌患者采用放化疗治疗具有良好治疗效果,治疗前后CEUS检查能明确肿瘤直径大小及肿瘤血流灌注改变情况,且诊断肿瘤灭活的准确度高,可为临床评估放化疗疗效提供重要数据参考。

Objective To study the value of contrast-enhanced ultrasonography(CEUS) in evaluating the efficacy of radiotherapy and chemotherapy in patients with advanced cervical cancer. Methods A total of 76 patients with advanced cervical cancer from October 2016 to July 2018 were selected as study subjects. All patients were treated with chemotherapy combined with three-dimensional conformal radiotherapy(3DCRT) and were divided into effective group(n = 61) and ineffective group(n = 15) according to the therapeutic effect. Before and after 4 cycles of chemotherapy,CEUS examinations were performed,the accuracy of CEUS in diagnosis of tumor inactivation was analyzed with pathological diagnosis as gold standard,and CEUS parameters were compared between two groups. Results After 4 cycles of chemotherapy,there were 36 cases of complete remission(CR),25 cases of partial remission(PR),10 cases of stable disease(SD),5 cases of disease progression(PD). The effective rate was 80. 26%(61/76). After treatment,the tumor diameter was significantly smaller than that before treatment [(13. 72 ± 3. 21) mm vs(38. 19 ± 4. 32) mm,t = 39. 636,P = 0. 000]. In 76 patients,86 tumor lesions were detected by CEUS with the accuracy of 91. 86%(79/86). After treatment,the values of RT,PI and AUC decreased,and MTT,TP increased compared with those before treatment in effective group(P< 0. 05). There were no statistical differences in above values before and after treatment in ineffective group(P >0. 05). Compared with ineffective group,the values of RT,PI,AUC decreased,and MTT,TP increased significantly in effective group(P< 0. 05,P< 0. 01).Conclusion In the patients with advanced cervical cancer,radiotherapy and chemotherapy have good therapeutic effect,and CEUS examination before and after treatment can determine the tumor diameter and the change of tumor blood perfusion with high accuracy of tumor inactivation. CEUS examination can provide important data reference for clinical evaluation of radiotherapy and chemotherapy.