自适应调强放射治疗对局部晚期宫颈癌的应用研究

Clinical study of adaptive intensity-modulated radiotherapy for locally advanced cervical cancer

目的 分析局部晚期宫颈癌(locally advanced cervical cancer,LACC)运用自适应调强适形放射治疗(adaptive intensity-modulated radiation therapy,ART)效果。方法 选取2019年2月至2022年2月浙江大学医学院附属第二医院临平院区收治的100例LACC患者为研究对象,采用随机数字表法将其分为对照组(n=50)与观察组(n=50)。对照组采用单程调强适形放射治疗,观察组采用ART治疗。行外照射治疗时,两组患者均运用逆向调强放射治疗或图像引导放射治疗技术,并同步实施以顺铂药物为基药的化疗方案。比较两组患者临床近期疗效、治疗期间药物不良反应及治疗后1年生存率。结果 观察组临床缓解率高于对照组,急性消化系统不良反应程度低于对照组,差异均有统计学意义(P<0.05);两组急性骨髓抑制与急性泌尿系统不良反应程度比较,差异无统计学意义(P>0.05);所有患者术后均进行1年随访,对照组存活46例,病死4例,总体生存时间为11.77[95%置信区间(confidence interval,CI):11.53~12.00]个月;观察组存活48例,病死2例,总体生存时间为11.95(95%CI:11.88~12.02)个月,两组生存率比较,差异无统计学意义(P>0.05)。结论 LACC患者采用ART治疗可提高近期临床疗效,不增加急性消化系统不良反应。

Objective To explore the effect of adaptive intensity-modulated radiation therapy(ART) for locally advanced cervical cancer(LACC). Methods A total of 100 LACC patients admitted to the Second Affiliated Hospital of Zhejiang University Medical College Linping Campus from February 2019 to February 2022 were selected as the research objects. According to the random number table method, they were divided into the control group(n=50) and the observation group(n=50). The control group was treated with single-pass intensity-modulated radiotherapy, and the observation group was treated with ART. When external beam irradiation was performed, both groups of patients used reverse intensity-modulated radiotherapy or image-guided radiotherapy technology, and simultaneously implemented a chemotherapy regimen with cisplatin as the base drug. The short-term clinical efficacy, side effects of drugs during treatment, and 1-year survival rate after treatment were compared between the two groups.Results The clinical remission rate of the observation group was higher than that of the control group,and the degree of acute digestive system toxicity in the observation group was lower than that in the control group, the differences were statistically significant(P<0.05). There was no significant difference in the degree of acute bone marrow suppression and acute urinary system toxicity between the two groups(P>0.05). All patients were followed up for 1 year after surgery. In the control group, 46 cases survived, 4 cases died of illness, and the overall survival time was 11.77 [95%(confidence interval, CI): 11.53-12.00] months;48 cases survived in the observation group, 2 cases died of illness, overall The survival time was 11.95(95%CI: 11.88-12.02) months.There was no statistically significant difference in the survival rate between the two groups(P>0.05). Conclusion The use of ART in LACC patients can improve the short-term clinical efficacy without increasing acute gastrointestinal toxicity.