三维宫旁插植后装放疗与体外调强放疗对宫颈癌患者膀胱、乙状结肠及直肠受照剂量的影响

Effects of three-dimensional parauterine implantation brachytherapy and external intensity-modulated radiotherapy on radiation doses of bladder,sigmoid colon and rectum in patients with cervical cancer

目的:探讨三维宫旁插植后装放疗与体外调强放疗对宫颈癌患者膀胱、乙状结肠及直肠受照剂量的影响。方法:选取110例宫颈癌患者为研究对象,根据治疗方式不同分为插植后装组和体外调强组,每组各55例。插植后装组采用三维宫旁插植后装放疗;体外调强组采用体外调强放疗。比较两组患者治疗效果、膀胱、乙状结肠及直肠的受照剂量、肿瘤标志物水平和急性不良反应。结果:两组患者治疗效果比较,差异无统计学意义(P>0.05),但插植后装组患者有效率高于体外调强组(P<0.05)。插植后装组膀胱、乙状结肠及直肠在1 cm^(3)、2 cm^(3)、5 cm^(3)体积的受照剂量低于体外调强组(P<0.05)。治疗前,两组患者癌胚抗原(CEA)、鳞状细胞癌抗原(SCC-Ag)、糖类抗原724(CA724)水平比较,差异无统计学意义(P>0.05);治疗后,两组患者CEA、SCC-Ag、CA724水平均较治疗前降低(P<0.05),但组间比较,差异无统计学意义(P>0.05)。两组患者急性膀胱炎、急性肾炎、急性肠炎之间有等级差异(P<0.05);插植后装组急性不良反应发生率低于体外调强组(P<0.05)。结论:与体外调强放疗相比,宫颈癌患者应用三维宫旁插植后装放疗治疗效果更好,膀胱、乙状结肠及直肠的受照剂量更低,CEA、SCC-Ag、CA724等肿瘤标志物水平降低,急性不良反应发生少,可推荐作为宫颈癌后期加量治疗方法。

Objective:To explore the effects of three-dimensional parauterine implantation brachytherapy and external intensity-modulated radiotherapy on radiation doses of bladder,sigmoid colon and rectum in patients with cervical cancer.Methods:110 cervical cancer patients were divided into implantation group and external intensity-modulated group according to the treatment method,with 55 cases in each group.Therapeutic effects,radiation doses of bladder,sigmoid colon and rectum,the levels of tumor markers and acute adverse reactions in the two groups were observed.Results:There was no statistical difference in therapeutic effect between the two groups(P>0.05),but the effective rate in the implantation group was higher than that in the external intensity-modulated group(P<0.05).The irradiated doses of bladder,sigmoid colon and rectum in the volume of 1 cm^(3),2 cm^(3)and 5 cm^(3)in the implantation group were lower than those in the external intensity-modulated group(P<0.05).Before treatment,there was no significant difference in the levels of carcinoembryonic antigen(CEA),squamous cell carcinoma antigen(SCC-Ag)and carbohydrate antigen 724(CA724)between the two groups(P>0.05).After treatment,the levels of CEA,SCC-Ag,and CA724 were lower than those before treatment in the two groups(P<0.05),there was no significant difference between the two groups(P>0.05).There were grade differences in acute cystitis,acute nephritis and acute enteritis between the two groups(P<0.05).The incidence of acute adverse reactions in the implantation group was lower than that in the external intensity-modulated group(P<0.05).Conclusion:Compared with external intensity-modulated radiotherapy,three-dimensional parauterine implantation brachytherapy is more effective in the treatment of cervical cancer patients,with lower radiation doses of bladder,sigmoid colon and rectum.Meanwhile,it can significantly lower the levels of tumor markers such as CEA,SCC-Ag,and CA724,and reduce the occurrence of acute adverse reactions.It is recommended as a treatment with increased dose for cervical cancer.