外阴癌术后调强适形放疗15例临床观察

Clinical Observation on 15 Cases of Intensity Modulated Radiation Therapy for Post-operative Vulvar Carcinoma

目的观察调强适形放射治疗在外阴癌术后患者中放疗的疗效及毒副反应。方法对外阴癌术后病理提示腹股沟淋巴结转移的患者,行术后放化疗同步治疗,放疗技术采用调强适形放疗,对术后复查仍存在腹股沟或盆腔淋巴结肿大的患者采用淋巴结局部同步加量。放疗靶区包括:GTVnd为术后体检或相关影像学检查存在腹股沟或盆腔淋巴结肿大;CTV为双侧腹股沟、髂外及髂内淋巴结引流区和(或)外阴局部。靶区的总剂量及分割剂量分别为:PGTVnd 59.8~62.1 Gy/26f,2.3~2.4 Gy/f;PTV 46.8~49.4 Gy/26f,1.8~1.9 Gy/f。结果放疗中1例淋巴结局部同步加量患者因放疗局部皮肤反应,中断放疗3周。余患者顺利完成放疗。治疗后随访时间4~54个月,中位随访时间36个月,1例患者治疗结束后4个月死亡,死亡原因不详;2例患者放化疗后出现淋巴结及远处转移,治疗后6个月及10个月后死亡。其余12例患者至今健在,定期随访,未见肿瘤复发转移。随访至今,存活患者中1例出现双下肢的轻度水肿,余11例未发生双下肢水肿,无1例发生肠瘘、放射性直肠炎、放射性膀胱炎等放疗相关远期副反应。结论调强适形放疗治疗外阴癌术后腹股沟淋巴结转移的患者,疗效好,毒副反应可耐受。

Objective To evaluate the efficacy and toxicity of IMRT in post-operative vulvar carcinoma.Methods From November 2014 to May 2016,15 cases of post-operative vulvar carcinoma with Inguinal lymph node metastasis received chemoradiation with concurrent cisplatin.IMRT was delivered to patients.The patients with positive lymph nodes accepted simultaneous integrated boost.The radiotherapy targets include GTV and CTV,The doses of PGTVnd were 59.8-62.1Gy/26f,2.3-2.4 Gy/f;and the dose of PTV were 46.8-49.4 Gy/26f,1.8-1.9 Gy/f.Results All patients except one completed chemoradiotherapy as prescribed.The follow-up time was 4-54 months,with a median follow-up time of 36 months.One patient died 4 months after treatment,the cause of death was unknown.Two patients were found to have node and lung metastasis.After treatment,the patients died 6 and 10 months later respectively.The remaining 12 patients are still alive.No recurrence or metastasis of the tumors has been found after regular follow-up.Up to now,1 case had mild edema in both lower limbs,the other 11 cases had no edema in both lower limbs,and no long-term side effects such as intestinal fistula,radiation proctitis and radiation cystitis occurred.Conclusions Intensity-modulated radiotherapy for the patients of post-operative vulvar carcinoma with Inguinal lymph node metastasis seems to be optimistic,the toxicities are tolerable and acceptable.