中晚期巨块型宫颈癌热疗配合同步放化疗的近期疗效观察

目的观察热疗配合同步放化疗配合治疗中晚期巨块型宫颈癌的近期疗效,同时评价影像学在放射治疗中随访的作用。方法 73例病理确诊Ⅱb～Ⅲb巨块型中晚期宫颈癌患者进行回顾性分析。试验组(热放化疗组)43例,对照组(放化疗组)30例。外照射采用6～18MVX射线前后野对穿或四野合式照射。DT 45～50Gy后。盆腔淋巴结转移DT56～60Gy。Ir-192 HDR腔内后装放疗,总处方剂量28～35Gy。每周1次,共5～6次。放疗开始同时配合3～4周TP方案的化疗。热疗每周2次,共6～8次在3～4周内完成。结果热放化疗组完全缓解(CR)30例(69.8%),部分缓解(PR)10例(20.9%)。治疗总有效率90.7%(CR为70%,PR为20.9%),放化疗组总有效率80.0%,完全缓解(CR)17例(56.7%),部分缓解(PR)7例(23.3%)。鳞状细胞相关抗原(SCC)明显下降63例。治疗结束及治疗后3个月复查B超、MRI或CT复查提示肿瘤明显缩小,完全退缩率100%。其中4例SCC升高影像检查提示肿瘤远处转移。急性毒性反应:Ⅲ度的骨髓抑制和急性胃肠道反应5例(12%)。结论中晚期巨块型宫颈癌放化疗及热疗联合应用,患者耐受性好,是一种有效可行的综合治疗方法。同时能提高晚期宫颈癌局部消退率。

Efficiency of Deep Hyperthermia Combined with Concurrent Chemo-Radiotherapy in the Advanced Cervical Cancer

Objective To observe recent effect and acute toxicity of hyperthermia combined with chemo-radiotherapy in advanced cervical cancer and evaluate the role of imaging followed by the treatment. Methods A total 73 cases of Ⅱb-Ⅲb stage cervical cancer patients confirmed pathologically From January 2009 to April 2011 were retrospectively analyzed. The external- beam radiotherapy （EBRT） was delivered using 6-18 MV X rays and either anterior-posterior and posterior-anterior （AP： PA） or four field techniques .Patients were prescribed 45- 50Gy. The positive Pelvic lymph node were boosted to 56 - 60 Gy. The total dose of HDR that received 5 - 6 fractions of 7Gy prescribed to point A was 28-35Gy. All patients were delivered with 3 - 4 circles TP regimen chemotherapy. Hyperthermia was given twice per week.6 - 8 times within 3-4 weeks. Response was assessed by physical examination and CT, MRI or ultrasonic examination three months later after completion of treatment combined with the gynecology clinic examination evaluation results. Results The complete remission （CR） was70% and the PR was 20.9%）. Total response rate was 90.7% .Squamous cell related antigen （SCC） decreased obviously in 63 cases .The end of treatment and following 3 months Ultrasonic, MRI or CT review suggested tumor decrease, completely rate was 100%. 4 cases of SCC raised suggest tumor distant metastases. Acute toxicity of Grade 3 blood bone marrow suppression and grade 3 gastrointestinal reactions in 5 cases, Conclusion Hyperthermia plus Chemo-radiotherapy is feasible and well tolerated in locally advanced cervical tumors. It can improve the late local control and cervical cancer patients with good tolerance; it was a safe and effective treatment mode to teat advanced cervical cancer