CT引导下腔内联合徒手插植在宫颈癌根治性放疗中的应用

Application of CT-guided intracavitary/freehand interstitial brachytherapy in radical radiotherapy for cervical cancer

目的探讨三维腔内联合徒手插植技术在宫颈癌根治性放疗中的临床应用价值。方法收集2019年4月—2021年9月于南京医科大学附属肿瘤医院采用CT引导下三维腔内联合徒手插植进行根治性放疗的宫颈癌患者的临床资料进行回顾性研究,分析短期疗效及不良反应,并以logistics风险回归模型评估影响短期疗效的独立预测因子。结果共计纳入182例患者,所有患者均顺利完成治疗,治疗结束3个月后,评估临床疗效发现治疗有效率达90.65%且在治疗期间下消化道3、4级不良反应发生率为4.4%;对IIIC期患者根据FIGO 2009标准重新分期并纳入影响分期的因素,发现患者近距离治疗前肿瘤体积是影响该期患者临床疗效的主要因素(P=0.004);结论作为宫颈癌根治性放疗中的关键手段,三维腔内联合徒手插植技术是安全有效的,可在地区肿瘤中心以外的基层院区快速普及开展宫颈癌近距离治疗。

Objective To investigate the clinical application of three-dimensional intracavitary/free-hand interstitial brachytherapy technique in radical radiotherapy for cervical cancer.Methods A retrospective study was conducted on the clinical data of patients with cervical cancer who underwent radical radiotherapy using CT-guided three-dimensional intracavitary/free-hand interstitial brachytherapy technique in The Affiliated Cancer Hospital of Nanjing Medical University from April 2019 to September 2021.The short-term efficacy and adverse reactions were analyzed,and the independent predictors affecting short-term efficacy were evaluated by logistic risk regression model.Results A total of 182 patients were included,and all patients successfully completed the treatment.Clinical efficacy assessment performed 3 months after treatment revealed an overall response rate of 90.65%;the incidence of grade 3 and 4 adverse reactions in the lower gastrointestinal tract was 4.4%during treatment.After reclassifying stage IIIC patients according to the International Federation of Gynecology and Obstetrics(FIGO)2009 staging system and including factors affecting the stage,it was found that the tumor volume before brachytherapy was the main factor affecting the clinical efficacy of patients at this stage(P=0.004).Conclusion As a key method in radical radiotherapy for cervical cancer,three-dimensional intracavitary/free-hand interstitial brachytherapy technique is safe and effective and can be quickly popularized in primary hospitals beyond regional cancer centers for cervical cancer brachytherapy.