局部中晚期宫颈癌宫旁插植放疗的临床疗效观察

Clinical efficacy of brachytherapy implantation in the treatment of local intermediate and advanced cervical cancer

目的探讨腔内联合宫旁插植治疗(IC/ISBT)和腔内后装治疗(ICBT)对局部晚期宫颈癌的临床疗效。方法选取经体外照射放疗(50 Gy/25 f)后肿瘤消退不明显且宫旁受侵的局部晚期(ⅡB~ⅢB期)宫颈癌患者100例。采用随机数字表法将患者分为ICBT组和IC/ISBT组,每组50例。然后进行CT,将图像传至Oncentra Brachy Therapy计划系统,行靶区勾画,采用模拟退火逆向优化方式进行计划设计,比较ICBT组和IC/ISBT组患者的近期疗效、肿瘤复发或转移率、并发症发生率。结果IC/ISBT组患者的完全缓解(CR)率为96.0%,高于ICBT组的88.0%,差异有统计学意义(P﹤0.05);IC/ISBT组患者的客观缓解率(ORR)为98.0%,高于ICBT组的92.0%,差异有统计学意义(P﹤0.05)。IC/ISBT组患者的肿瘤复发或转移率为4.0%,低于ICBT组的16.0%,差异有统计学意义(P﹤0.05)。IC/ISBT组患者放射性皮炎的发生率为38.0%,与ICBT组的42.0%比较,差异无统计学意义(P﹥0.05);IC/ISBT组患者放射性直肠炎的发生率为14.0%,低于ICBT组的32.0%,差异有统计学意义(P﹤0.05);IC/ISBT组患者放射性膀胱炎的发生率为30.0%,与ICBT组的28.0%比较,差异无统计学意义(P﹥0.05)。结论对外照射后肿瘤消退不明显、宫旁受侵的局部晚期宫颈癌患者采用IC/ISBT治疗方式,可取得较好的宫旁控制率和近期疗效,且能够降低放射性直肠炎的发生率,值得临床推广应用。

Objective To explore the clinical efficacy of intracavitary and para-cercix interstitial brachytherapy(IC/ISBT)and intracavitary brachytherapy(ICBT)in the treatment of local intermediate and advanced cervical cancer.Method 100 patients with local intermediate and advanced cervical cancer(stage IIB-IIIB)who underwent external beam radiation therapy(EBRT)(50 Gy/25 f)with no obvious tumor regression and with paracervical invasion were included and randomly divided into the ICBT group(n=50)and IC/ISBT group(n=50).Images were transfered to Oncentra Brachy Therapy planning system after CT scanning.The target area was delineated,the planned design was conducted by using inverse planning simulated annealing(IPSA),the short-term efficacy,tumor recurrence/metastasis rate and incidence of adverse reactions between ICBT group and IC/ISBT group were compared.Result The complete response(CR)rate and objective response rate(ORR)in IC/ISBT group were higher than those in the ICBT group(96.0%vs 88.0%,98.0%vs 92.0%,P<0.05).The tumor recurrence/metastasis rate in the IC/ISBT group was lower than that in the ICBT group(4.0%vs 16.0%,P<0.05).There was no significant difference for incidence of radioactive dermatitis between IC/ISBT group and ICBT group(38.0%vs 42.0%,P>0.05).The incidence of radioactive proctitis in the IC/ISBT group was lower than that in the ICBT group(14.0%vs 32.0%,P<0.05).There was no significant difference for the incidence of radioactive cystitis between IC/ISBT group and ICBT group(30.0%vs 28.0%,P>0.05).Conclusion For local intermediate and advanced cervical cancer patients with paracervical invasion but without obvious tumor regression after external radiation,IC/ISBT can provide better paracervical control rate and short-term efficacy and reduce the incidence of radiation proctitis.Therefore,it is worthy of clinical promotion and application.