ⅡB期宫颈癌CT引导下三维近距离治疗预后因素及靶区体积的差异性探讨

Prognostic factors of CT-guided 3D brachytherapy in patients with stageⅡB cervical cancer and the difference of target volume delineation

目的分析ⅡB期宫颈癌CT引导下三维近距离治疗患者的预后相关因素及探讨不同的靶区勾画体积对局部控制率的影响。方法回顾贵州省肿瘤医院2014年1月至2016年12月的120例ⅡB期宫颈癌患者的临床资料,按三维近距离治疗时高危临床靶区(the high-risk clinical target volume,VHR CTV)以29.46 cm^3(中位数)为界,VHR CTV≤29.46 cm^3者为小体积组,VHR CTV>29.46 cm^3者为大体积组,分析预后因素及临床疗效、放疗副反应。结果①总体患者3年无进展生存时间(PFS):77.1%,总生存期(OS):78.7%,无局部区域复发生存率(LRRFS):92.1%。大小体积组3年OS、PFS和LRRFS差异无统计学意义(P>0.05);②117例治疗有效的患者中2组疗效相当;③两组患者直肠、膀胱受量差异无统计学意义(P>0.05);④两组患者放射副反应差异无统计学意义(P>0.05)。结论①本组患者中未发现影响IIB期宫颈癌患者的独立生存预后因素;②本组患者局部控制率与VHR CTV大小无相关性;③两组患者膀胱、直肠受量和放射性副反应发生率差异无统计学意义(P>0.05)。

Objective To analyze the prognostic factors of three-dimensional brachytherapy guided by CT in patients with stageⅡB cervical cancer,and the effect of the volume of different target areas on local control rate.Methods The clinical data of 120 patients with stageⅡB cervical cancer were retrospectively analyze.According to the high-risk clinical target volume(VHR CTV)treated in 3D brachytherapy,all the patients were sorted as the smaller group if the VHR CTV≤29.46 cm3(median value),and as the larger group if VHR CTV>29.46 cm3.The prognostic factors,clinical efficacy and radiotherapy side effects were analyzed.Results①Overall persistent 3-year PFS:77.1%,OS:78.7%,LRRFS:92.1%.Prognostic single factor analysis:Concurrent chemoradiotherapy was a prognostic factor for LRFFS.There were no statistical differences in OS,PFS,LRFFS the efficacy,and in the doses of the rectum and bladder betweentwo groups.②Side effects:There was not any statistical differences in radiation side effects between two groups.Conclusions①This study did not find independent prognostic factors affecting patients with stageⅡB cervical cancer.②There was not any correlation between the local control rate in the size of VHR CTV.③There was no significant difference in bladder,rectal dose and the incidence of radioactive side reactions between different VHR CTV groups.