宫颈细胞学ASCUS/LSIL的临床意义及处理

目的探讨宫颈不典型鳞状上皮，低度鳞状上皮内病变（ASCUS／LSIL）的临床意义及处理方法。方法对中国医学科学院肿瘤医院2004～2006年妇科门诊用TCT（宫颈液基细胞学）的方法检出的254例ASCUS／LSIL以病理结果为金标准进行回顾性分析，其中136例进行了阴道镜检查。结果在140例ASCUS中，宫颈上皮内瘤变（CIN）病变占51．5％，其中高度病变占22．9％，114例LSIL中CIN病变占59．6％，其中高度病变占30．7％，两组资料比较差异无统计学意义，P〉0．05。其中136例中阴道镜诊断炎症47例，低度宫颈上皮内病变53例，高度宫颈上皮内病变36例及病理检查结果炎症55例，低度宫颈上皮内病变41例，高度宫颈上皮内病变40例，阴道镜与病理对照进行了～致性检验，Kappa=0．314，U=0．064，P〈0．05，一致性好。病理证实人乳头状瘤病毒（HPV）阳性的妇女中CIN发生率79％（67／84），而HPV阴性者中CIN发生率43．5％％（74／170），结果显示两组资料比较差异有统计学意义，X^2=29．88，P〈0．05。本组资料中年龄在35～55岁的妇女占83．5％与HPV阳性的妇女年龄高峰一致。结论对ASCUS的患者应与LSIL同样重视，立即进行阴道镜检查以避免22．9％的高度病变的患者漏诊或失访，对35～55岁的HPV感染的妇女应更加重视。     

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.     

25例妇科复发性恶性肿瘤三维适形放疗观察

[目的]观察复发性妇科恶性肿瘤三维适形放疗的疗效和副作用。[方法]25例复发性妇科恶性肿瘤接受三维适形放疗,其中外院手术放疗后复发转移16例,本院初次治疗9例。单纯适形放疗13例,先盆腔大野放疗再加适形放疗12例。[结果]全组有效率76%(19/25),CR9例,PR10例,13例单纯适形放疗中CR7例,PR3例,12例常规加适形放疗中CR2例,PR7例。目前存活16例,无瘤存活9例,带瘤存活7例。全组总中位存活28.5个月,复发后中位存活11.4个月。血液学毒性轻到中度,无肝肾功能损害及膀胱炎,少数患者有放射性直肠炎。[结论]三维适形放疗治疗复发性妇科恶性肿瘤具有明显剂量分布优势,肿瘤缓解率高,副反应低。单纯适形放疗显示疗效优势。     

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...     

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。     

多通道施源器用于晚期宫颈癌三维腔内放疗的剂量学研究

目的 探讨中晚期宫颈癌三维后装腔内放疗中三通道施源器的通道设计与OAR、靶区剂量间关系。方法 调取2015—2016年我院三维腔内治疗的15例中晚期宫颈癌数据,其中30次“阴道卵形两半球+宫腔管”的三通道施源器剂量参数纳入研究。在原靶区和OAR勾画、处方剂量不变基础上保留宫腔管单通道施源器,重新进行三维腔内照射设计的剂量参数作为对照组,配对t检验两组OAR剂量参数。结果 三通道、单通道施源器组直肠D_2cc分别为(387.8±96.8)、(340.8±88.1) cGy;两组膀胱和乙状结肠D_2cc分别为(443.2±87.5)、(719.4±243.0) cGy和(330.3±88.8)、(383.1±105.6) cGy。三通道组满足直肠(D_2cc≤500 cGy)、膀胱(D_2cc≤550 cGy)和乙状结肠(D_2cc≤500 cGy)计划限量,单通道组膀胱和乙状结肠D_2cc受量分别为大于和部分大于计划限量。单通道组膀胱和乙状结肠D_2cc受量高于三通道组(P均<0.05)。结论 宫颈癌三维腔内放疗中“阴道卵形两半球+宫腔管”三通道施源器比宫腔管单通道可有效降低膀胱和乙状结肠受量,有利于计划优化和剂量实施。     

宫颈癌多次计划CT引导三维近距离治疗可行性研究

目的 探讨宫颈癌患者多次计划CT引导的三维近距离治疗可行性及对危及器官剂量学影响。
方法 10例接受根治性放疗的Ⅱ_b~Ⅲ_b期宫颈癌患者每次腔内放疗前行CT扫描并勾画高危临床靶体积(HRCTV)及膀胱、直肠、乙状结肠。PLATO14.3计划系统设计,HRCTV采用D₉₀,危及器官采用D_{2 cm³}评价。处方剂量A点7 Gy单次后进行几何优化,直肠、乙状结肠D_{2 cm³}≤5 Gy,膀胱D_{2 cm³}≤5.5 Gy。第1次腔内治疗优化计划为标准计划,每次腔内放疗进行CT扫描制定几何优化计划。两组计划参数行独立样本t检验,危及器官体积与参数相关性采用Pearson法相关分析。
结果
标准计划与优化计划HRCTV的D₉₀相似(t=－0.03~－1.61,P=0.978~0.128),膀胱、直肠、乙状结肠D_{2 cm³}不同(t=－2.27~－3.35,P=0.049~0.004)。膀胱、直肠、乙状结肠体积与各自D_{2 cm³}均呈正相关(r=0.314、0.407、0.539,P=0.026、0.003、0.000)。
结论 CT引导的宫颈癌三维近距离治疗中多次计划有必要,危及器官体积对治疗CTV剂量无影响,但体积越大受照最多部位的D_{2 cm³}越高。     

宫颈癌放射治疗的研究进展

宫颈癌发病率居我国女性生殖道恶性肿瘤之首,约80%宫颈癌患者在治疗过程中需要接受放射治疗,包括术后辅助放疗、根治性放疗和复发宫颈癌放疗。笔者拟分别对体外放射治疗(EBRT)和近距离放射治疗(BT)的研究进展、靶区勾画、实施方式、优势和不足进行阐述如下。     

MiR-19a与宫颈癌同步放化疗敏感相关性研究

目的:探讨miR-19a与中晚期宫颈癌同步放化疗敏感性的相关性及可能作用机制。方法:收集行同步放化疗治疗的ⅡB～ⅢB期宫颈鳞状细胞癌患者20例,根据其治疗后6个月的近期治疗效果分为治疗敏感组和抗拒组,每组各10例,治疗前收集宫颈肿瘤组织并提取总RNA;利用TaqMan Real-time PCR法检测miR-19a在两组间的表达情况,统计分析其与同步放化疗敏感性的相关性。结果:敏感组随访10～20个月,截止末次随访均未发现肿瘤复发。抗拒组治疗中肿瘤进展2例,治疗结束6个月内肿瘤残存或出现新发病灶者8例。两组患者在临床分期、年龄、组织分级、淋巴结转移、局部肿瘤大小、Scc-Ag水平和治疗时间各个临床因素差异无统计学意义,P值均>0.05;miR-19a在治疗抗拒组中的表达水平约为1.0±0,敏感组为4.80±1.15,两组比较差异有统计学意义,P<0.05。结论:miR-19a与中晚期宫颈癌同步放化疗敏感性相关,可能成为预测宫颈肿瘤内在放化疗敏感性的标志,对尽早施行个体化治疗以改善预后有重要意义。