宫颈癌调强放疗时盆腹腔转移淋巴结同步加量放疗与后程加量放疗的临床疗效与毒副反应观察

The clinical effect and toxicity of simultaneously integrated boost intensity-modulated radiotherapy and lately integrated boost intensity-modulated radiotherapy for cervical cancer patients with pelvic and abdominal lymph node metastasis

目的比较宫颈癌盆腹腔转移淋巴结行调强放疗时不同加量程序的应用效果,并观察其安全性。方法选取2014年1月至2017年1月内蒙古自治区人民医院诊治的92例宫颈癌伴盆腹腔淋巴结转移患者作为研究对象。按照随机数字表法将其平均分为研究组和对照组,每组46例患者。两组患者均接受调强放疗,研究组患者采用同步加量放疗,对照组患者采用后程加量放疗,比较两组患者临床疗效和毒副反应。结果研究组患者外照射时间和总体治疗完成时间均短于对照组患者,其差异均具有统计学意义(均P<0.05);研究组患者无论是放疗完成时还是放疗3个月后,完全缓解(complete remission,CR)人数均高于对照组患者,其差异具有统计学意义(P<0.05);研究组患者小肠、股骨头、直肠、膀胱等危险器官平均受照射剂量均明显小于对照组患者,其差异均具有统计学意义(均P<0.05);与对照组患者相比,研究组患者出现消化道、泌尿系统和白细胞等毒副反应明显减少,且未出现Ⅲ级毒副反应,其差异均具有统计学意义(均P<0.05)。随访两组患者生存情况发现,研究组患者生存超过1年和超过18个月人数均高于对照组患者;两组患者远期并发症发生率比较,其差异无统计学意义(P>0.05)。结论采用同步加量调强放疗有助于提高宫颈癌伴盆腹腔转移淋巴结患者的病情缓解率,且治疗期间不会增加毒副反应,可以延长患者生存期限,值得临床借鉴。

Objective To study the clinical effect and toxicity of simultaneously integrated boost intensity-modulated radiotherapy and lately integrated boost intensity-modulated radiotherapy for cervical cancer patients with pelvic and abdominal lymph node metastasis.Methods The clinical data of 92 cervical cancer patients with pelvic and abdominal lymph node metastasis treated from January 2014 to January 2017 in People′s Hospital of Inner Mongolia Autonomous Region was collected.Patients were randomly assigned to control group(n=46)and study group(n=46).The study group received the simultaneously integrated boost intensity-modulated radiotherapy;the control group received the lately integrated boost intensity-modulated radiotherapy.The clinical effect and toxicity were probed.Results The external irradiation time and overall treatment time in the study group was shorter than that in the control group,with statistically significant differences(all P<0.05).After radiotherapy and 3 m of radiotherapy,the complete response(CR)rate in the study group was higher than that in the control group,with statistically significant differences(P<0.05).The mean irradiation dosage of the small intestine,femoral head,rectum,bladder and other key organs in the study group was lower than that in the control group,with statistically significant differences(all P<0.05).Compared with control group,the side reaction rate of alimentary tract,urinary system and leukocyte in the study group was remarkably reduced;besides,the study group had no stageⅢof toxic and adverse reactions(all P<0.05).During the follow-up visit,the ratio of having survival time over 12 m and 18 m in the study group was higher than that in the control group;the long-term complication rate between groups showed no statistically significant differences(P>0.05).Conclusions The simultaneously integrated boost intensity-modulated radiotherapy can increase the complete response rate and extend the patient′s survival time,with no effect in the toxic and adverse reactions,which should be recommended in clinical practice.