宫颈癌放射治疗远期疗效的临床研究

目的：明确宫颈癌单纯放疗时低、高剂量率近距离治疗、外照射中线挡铅与否的远期疗效和放射性损伤,指导宫颈癌放射治疗技术改进。方法：回顾性分析了240例Ⅰ～Ⅲ期宫颈癌的放射治疗后的长期随访结果,比较低、高剂量率后装治疗和盆腔大野中线挡铅与否的疗效和副作用。结果：全组随访时间为13～16a,中位随访时间14.6a,随访率90%。10a总生存率为69.17%。Ⅰ期10a生存率100%,Ⅱ期83.05%,Ⅲ期46%。低剂量率组10a生存率Ⅰ期是100%,Ⅱ期64.71%,Ⅲ期42.86%。高剂量率组10a生存率是Ⅰ期92.31%,Ⅱ期62.69%,Ⅲ期41.38%。低、高剂量率组Ⅰ期中线挡铅与不挡铅的10a生存率分别为100%、100%和100%、100%;Ⅱ期的10a生存率分别是64.52%、65%和63.89%、61.29%。Ⅲ期的10a生存率分别是40%、45.45%和43.33%、39.29%。经过显著性检验,P〉0.05。本组3、4级放射性直肠炎总发生率为13.13%,其余均为1、2级放射性直肠炎,挡铅组的副反应较轻。放射性膀胱炎发生率为8.8%,多为1、2级。结论：低、高剂量率近距离治疗的疗效均较好,后者较前者具有较多的优越性,建议推广使用高剂量率近距离治疗,对经济状况不好的病人,可以采用盆腔大野照射,但应降低近距离照射的剂量。

LONG TERM EFFECTIVENESS FOR CERVICAL CANCER PATIENTS TREATED WITH RADIOTHERAPY

Objective：To analyse the therapeutic effect and side-effect s of LDR and HDR brachy therapy combined with external beam radiation therapy（EBRT）in cervical cancer.Methods：240 Cervical cancer patients in stageⅠ-Ⅲwere t reated with LDR（group A）and HDR（group B）brachytherapy combined with EBRT.The efficacy of treatment and rate of side-effects were retrospectively analyzed.Results： All patients were followed up 13-16 years.10-year total survival rate in stage Ⅰ,Ⅱand Ⅲ was respectively：100%,83.05% and 46%;100%,64.712% and 42.86% in group A;92.31%,62.69% and 41.38% in group B;100%,64.52% and 40% in group A（block）;100%,63.89% and 43.33% in group B（block）;100%,65% and 45.45% in group A（unblock）;100%,61.29% and 39.29% in group B（unblock）.P0.05.The rate of severe radiation proctitis was 13.13%,radiation cystitis 8.8%.Condusion：LDR and HDR brachy therapy combined EBRT are effective with acceptable side-effect s in the t reatment of cervical cancer.The later is superior to the former.HDR brachytherapy should be recommended.A middle dose of 50 Gy to the whole plevis can be used for the patients in straitened condition,but the dose of the intracavitary radiation should be cut down.