Efficacy of preoperative intracavitary brachytherapy and surgery in patients with stage ⅠB2 and ⅡA bulky cervical cancer

Objective To analyze the outcomes of preoperative intracavitary brachytherapy plus sur-gery in patients with stage ⅠB2 and ⅡA bulky cervical cancer. Methods From January 2001 to January 2007, 77 patients with stage ⅠB2 and ⅡA bulky cervical cancer were included. The diameter of primary tumor was greater than 4 cm. Preoperative intracavitary brachytherapy with the total dose of 20-30 Gy (0.5 cm below the vaginal mucosa) was delivered by 2-3 fractions, one fraction per week. After an interval of 10-14 days, the efficacies of radiotherapy were evaluated and radical hysterectomy with pelvic lymphade-nectomy was performed. Then the treatment complications, clinicopathological characteristics, survival and recurrence were analyzed. Results The tumor shrinkage was observed in all the patients after intracavitary brachytherapy. The CR, PR and SD were 5% (4/77), 36% (28/77) and 58% (45/77), respectively. Radical hysterectomy was successfully performed in all patients. The complications of the combined therapy were mild and only 5 patients had grade Ⅱ or less hematological or gastrointestinal toxicities. The 5-year o-verall survival rate and pelvic recurrence rate were 83% and 12%, respectively. Conclusions Preoperative intracavitary brachytherapy of 20-30 Gy plus surgery is effective in the treatment of stage ⅠB2 and ⅡA bulky cervical cancer without increasing the treatment complications.     

干扰素治疗30例宫颈上皮内瘤样病变临床分析

目的:探讨干扰素治疗宫颈上皮内瘤样病变(Cervical Intraepithelial Neoplasia,CIN)的效果。方法:回顾性分析2004年6月~2004年12月复发CINⅠ30例患者进行重组人干扰素α-2b注射液宫颈局部注射治疗的临床资料。结果:治疗后第3、6、12和18个月的治愈率分别是76.7%(23/30)、86.6%(26/30)、93.3%(28/30)和61.5%(8/13),合并轻微发热、月经失调等不良反应。结论:CIN病变区域注射干扰素更能提高宫颈局部自身的免疫力,癌前病变的转阴率最高在治疗后第12个月,干扰素适宜治疗复发CINⅠ。     

DCE-MRI对宫颈鳞癌同步放化疗疗效的预测研究

目的：探讨动态增强MRI（DCE-MRI）对宫颈鳞癌同步放化疗疗效的预测价值。方法：研究对象选取2009年10月-2012年1月于我院行同步放化疗、并于治疗前、治疗末（常规治疗结束时）行DCE—MRI扫描的88例宫颈鳞癌患者。测量治疗前肿瘤及肌层DCE—MRI的时间信号强度曲线（TIC）类型及半定量参数,并计算肿瘤与肌层的比值,包括相对正性增强积分（rPEI）、相对最大上升斜率（rMsI）、相对最大下降斜率（rMSD）、增强后15S、30s、45s及60s的相对信号增强比率（rSER）、相对最大信号增强比率（rSERmax）及肿瘤达峰时间（TTP）。于治疗末依据肿瘤残存情况分为完全缓解（CR）组（56例）及部分缓解（PR）组（32例）,对组间DcE-MRI半定量参数进行统计学比较,并采用受试者工作特征（ROC）曲线分析治疗前参数预测治疗末肿瘤残存的诊断闽值及效能。结果：CR组治疗前rPEI、rMSI、rSER、rSER。及rSER。均高于PR组,且差异均有统计学意义（P值分别为〈0．001、〈0．001、0．045、〈0．001及〈0．001）。ROC曲线分析显示以治疗前rPEI≤0．84预测肿瘤同步放化疗后残存,其敏感度、特异度、阳性预测值、阴性预测值及诊断符合率分别为75．0％、69．6％、58．5％、83．O％及71．6％,曲线下面积（AUC）为0．785（P〈0．001）。结论：治疗前DCE-MRI半定量参数能在一定程度上预测宫颈鳞癌治疗结束时的疗效,有助于临床实施肿瘤个体化精确治疗。     

宫颈癌根治性手术后辅助调强放疗(IMRT)的临床观察

目的 探讨早期宫颈癌术后具有不良预后因素的患者行盆腔调强放射治疗(IMRT/sIMRT)的近期不良反应和复发率.方法 回顾分析2007年1月～2008年6月期间78例早期宫颈癌术后具有不良预后因素行放射治疗的患者资料,其中IMRT组有30例;常规组48例.调强放射治疗方法(IMRT/或sIMRT):CTV上界从腹主动脉...     

Efficacy of preoperative intracavitary brachytherapy and surgery in patients with stage ⅠB2 and ⅡA bulky cervical cancer

Objective To analyze the outcomes of preoperative intracavitary brachytherapy plus sur-gery in patients with stage ⅠB2 and ⅡA bulky cervical cancer. Methods From January 2001 to January 2007, 77 patients with stage ⅠB2 and ⅡA bulky cervical cancer were included. The diameter of primary tumor was greater than 4 cm. Preoperative intracavitary brachytherapy with the total dose of 20-30 Gy (0.5 cm below the vaginal mucosa) was delivered by 2-3 fractions, one fraction per week. After an interval of 10-14 days, the efficacies of radiotherapy were evaluated and radical hysterectomy with pelvic lymphade-nectomy was performed. Then the treatment complications, clinicopathological characteristics, survival and recurrence were analyzed. Results The tumor shrinkage was observed in all the patients after intracavitary brachytherapy. The CR, PR and SD were 5% (4/77), 36% (28/77) and 58% (45/77), respectively. Radical hysterectomy was successfully performed in all patients. The complications of the combined therapy were mild and only 5 patients had grade Ⅱ or less hematological or gastrointestinal toxicities. The 5-year o-verall survival rate and pelvic recurrence rate were 83% and 12%, respectively. Conclusions Preoperative intracavitary brachytherapy of 20-30 Gy plus surgery is effective in the treatment of stage ⅠB2 and ⅡA bulky cervical cancer without increasing the treatment complications.     

Efficacy of preoperative intracavitary brachytherapy and surgery in patients with stage ⅠB2 and ⅡA bulky cervical cancer

Objective To analyze the outcomes of preoperative intracavitary brachytherapy plus sur-gery in patients with stage ⅠB2 and ⅡA bulky cervical cancer. Methods From January 2001 to January 2007, 77 patients with stage ⅠB2 and ⅡA bulky cervical cancer were included. The diameter of primary tumor was greater than 4 cm. Preoperative intracavitary brachytherapy with the total dose of 20-30 Gy (0.5 cm below the vaginal mucosa) was delivered by 2-3 fractions, one fraction per week. After an interval of 10-14 days, the efficacies of radiotherapy were evaluated and radical hysterectomy with pelvic lymphade-nectomy was performed. Then the treatment complications, clinicopathological characteristics, survival and recurrence were analyzed. Results The tumor shrinkage was observed in all the patients after intracavitary brachytherapy. The CR, PR and SD were 5% (4/77), 36% (28/77) and 58% (45/77), respectively. Radical hysterectomy was successfully performed in all patients. The complications of the combined therapy were mild and only 5 patients had grade Ⅱ or less hematological or gastrointestinal toxicities. The 5-year o-verall survival rate and pelvic recurrence rate were 83% and 12%, respectively. Conclusions Preoperative intracavitary brachytherapy of 20-30 Gy plus surgery is effective in the treatment of stage ⅠB2 and ⅡA bulky cervical cancer without increasing the treatment complications.     

宫颈癌近距离放射治疗新进展

根治性同步放化疗是ⅡB～ⅣA期宫颈癌患者的主要治疗手段,近距离放射治疗（brachytherapy,BT）是其中重要的部分。近年图像引导的三维近距离放射治疗（image-guided adaptive brachytherapy,IGABT）发展迅速,逐渐引入三维靶区概念、DVH评估等新方式,可有效提高宫颈癌根治性放疗疗效并降低不良反应,但新技术在临床应用中仍存在部分不确定性,且对于如何与精确体外放疗相结合仍需进一步探索。     

宫颈癌调强适形放射治疗与三维适形放射治疗的剂量学比较

目的通过比较调强放射治疗（IMRT）与三维适形放射治疗（3DCRT）两种不同照射技术,探讨宫颈癌根治性放射治疗采用调强放射治疗技术对危及器官的保护。方法10例常规体外和腔内放射治疗的Ⅱ_b～Ⅲ_b宫颈癌患者,放疗前行CT扫描并勾画靶区。临床靶区（CTV）包括子宫、宫颈、阴道等原发肿瘤区域及髂总、髂外、髂内、闭孔、骶前淋巴结等区域和其周围组织,计划靶区（PTV）以CTV为基础外放前向10 mm/余各向5 mm形成PTV,处方剂量分别为95%PTV 45Gy、54Gy和63Gy/1.8Gy×25、30和35次,通过DVH图比较两种治疗技术危及器官受照体积与剂量的变化。结果相同处方剂量不同照射技术比较,膀胱和小肠受照体积与剂量IMRT均小于3DCRT照射（P〈0.05）;而直肠处方剂量分别为45GY、54GY及63GY时,直肠接受剂量分别高于30Gy、40Gy及50Gy（P〈0.05）的体积,IMRT明显小于3DCRT。不同处方剂量相同照射技术比较,在3DCRT照射技术方面：当处方剂量为63Gy时,膀胱接受40Gy和50Gy剂量的体积分别为93.10±8.77%和81.00±12.81%,明显高于处方剂量为45Gy和54Gy的体积（P=0.000）;对于直肠,随着处方剂量的提高,其受照体积轻微增大（P〉0.05）;相对小肠而言,处方剂量为54Gy和63Gy时,受照体积变化不大（P〉0.05）,但处方剂量为45Gy时,小肠受照剂量高于30Gy的体积小于处方剂量为54Gy或63Gy时的照射体积（P〈0.05）。在IMRT照射技术方面：随着处方剂量的提高,膀胱和小肠受照体积及剂量随之增加（处方剂量为54Gy与63Gy时的V_（20）比较P〉0.05,其余均P〈0.05）;对于直肠接受剂量高于30Gy的体积随处方剂量的提高而增加（处方剂量为54Gy与63Gy时的V_（30）比较P=0.376,其余均P〈0.05）。结论随着计划靶区内照射剂量的提高,膀胱、直肠及小肠接受的剂量和体积均随之增高,对危及器官的保护IMRT均优于3DCRT。     

专家答疑

1.如何检测HPV? HPV感染的检测方法有很多种,包括杂交捕获2代(HC2)、多聚酶链反应(PCR)、Southern-blot、原位杂交等。目前只有HC 2方法获得了美国FDA的批准可以应用于临床。HC2技术可定量分析样本中13种高危型HPV DNA总量,包括