以三维适形放疗推量的宫颈癌治疗的初步研究

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以三维适形放疗推量的宫颈癌治疗的初步研究

崔立春,耿会生,杨正浩,王　璇,李　欣,许世成

Clinica l study of cervica l cancer trea ted w ith m ore dose by the three di m ensiona l confor2 m a l radia tion(3-DCRT)w ithout afterloading irradia tion

CU IL i-chun,GENG Hui-sheng,Y ANG Zheng-hao,WANG Xuan,L I Xin,XU Shi-cheng

D epart m ent of O ncology,Chang an Hospital,Shaanxi X i’a n710016,China.

【Abstract】　O bjecti ve:To evaluate the feasibility and the therapeutic effect which the cervical cancers obtained

more dose by the di m ensi onal confor mal radiati on(3-DCRT)without afterl oading irradiati on,and comp licati ons of

rectu m or bladder.M ethods:Sixty cases of cervical cancers were random ly all ocated int o t w o gr oup s.The test

gr oup(26cases,3-DCRT),the contr ol gr oup(34cases,external radiati on and afterl oading irradiati on).After

received40Gy/20fracti ons of external radiati on t o the whole pelvic,Patients in the test gr oup were reduced radiati on

fields by3-DCRT,the t otal dose65～70Gy in general,no more than75Gy,in the contr ol gr oup received45～

50Gy external radiati on t o the para metrriu m,and point A received30Gy by afterl oad irradiati on(4～7.5Gy per frac2

ti on,1～2fracti ons per week).Results:The effect of the2gr oup s were affir mative,the rates of acute comp licati on

for the rectu m were significantly l ower in the test gr oup than in the contr ol gr oup,the rates of comp licati on f or the

bladder were si m illar,and the res ponse of the test gr oup was slightly.Conclusi on:The3-DCRT without afterl oad2

ing irradiati on of cervical cancer may decrease the comp licati on for rectu m or bladder and the short-ter m effect is af2

fir mative.

【Key words】cervical carcinoma;afterl oading irradiati on;the di m ensi onal confor mal radiati on;comp licati onal radia2

ti on

Modern Oncol ogy2007,15(8):1175～1177

【摘要】　目的:研究宫颈癌去除后装腔内治疗以三维适形放疗推量的可行性、治疗效果及对直肠膀胱并发症

发生的影响。方法:60例宫颈癌,随机分组,去除后装组(观察组)26例,外照射结合后装组(对照组)34例。

大野照射40Gy/20次后,观察组缩野三维适形照射,总剂量65～70Gy左右,不超过75Gy;对照组中央铅挡盆

腔照射给宫旁补量,使外照射B点剂量达45～50Gy;后装治疗补充A点剂量30Gy左右(4～7.5Gy/次,1～2

次/周)。结果:两组近期疗效确切,观察组急性消化道发生率低,泌尿系反应发生率相似,观察组反应相对较

轻。结论:宫颈癌去后装三维适形放疗可以明显减少急性放射性直肠炎、膀胱炎的发生,近期疗效确切。

【关键词】宫颈癌;后装照射;三维适形放疗;并发症

【中图分类号】R737.33 【文献标识码】A 【文章编号】1672-4992-(2007)08-1175-03

自2005年9月份以来,我们对未能手术的26例宫颈癌患者开始采用后程三维适形放疗推量,代替后装腔内治疗,和同期行外照射结合后装治疗的观察组相比较,近期疗效确切,并发症轻,具体报告如下:

1　材料与方法

1.1　一般资料　

60例门诊或住院的宫颈癌患者均经病理确诊。将其随机分为去后装治疗组(观察组)26例和同期外照射结合后装治疗组(对照组)34例。观察组年龄38岁～68岁,中位年龄54岁;病理类型中鳞癌22例,腺癌3例,低分化类癌1例;临

【收稿日期】　2006-11-15

【修回日期】　2007-03-29

【作者单位】　陕西西安长安医院肿瘤科,陕西　西安　710016

【作者简介】　崔立春(1971-),男,陕西咸阳人,主治医师,主要从事肿瘤的放射治疗及综合治疗。床分期:II a期3例,II b期18例,III a期3例,III b期2例。对照组年龄32岁～65岁,中位年龄52岁;病理类型中鳞癌31例,腺癌3例;临床分期:II a期2例,II b期26例,III a期5例, III b期1例。两组患者资料差异无统计学意义。

1.2　治疗方法　

观察组:开始先采用大野盆腔适形野照射40Gy/20次,缩野三维适形照射宫体、宫颈及周围宫旁组织,推量至60Gy 左右,继续缩野照射宫颈肿瘤区及部分宫体区,总量65～70Gy,根据患者肿瘤分期,肿瘤大小,必要时继续缩野,单纯照射宫颈肿瘤区域,总照射量不超过75Gy,结束治疗。对照组:全盆腔照射40Gy/20次后,中央铅挡与腔内后装放疗同时进行,中央铅挡盆腔照射给宫旁补量,使外照射B点剂量达45～55Gy;后装治疗补充A点剂量30Gy左右(4～7.5Gy/次,1～2次/周)。放疗总时间基本接近,平均为6～7周。1.3　疗效观察及评定标准　

治疗3个月后进行疗效评价,疗效评定以肿瘤局部情况

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现代肿瘤医学　2007年8月　第15卷第8期