CT引导下三维腔内后装放疗联合体外调强化疗在治疗晚期宫颈癌的应用价值

【摘要】目的:探讨CT引导下三维腔内后装放疗联合体外调强放疗（IMRT）、顺铂治疗晚期宫颈癌的效果。方法:选取97例晚期宫颈癌患者进行回顾性研究，其中55例患者采用CT引导下三维腔内后装放疗联合IMRT、顺铂治疗（观察组），42例患者采用二维腔内后装放疗联合IMRT、顺铂治疗（对照组）。观察并比较两组患者治疗前后效果、危及器官放射损伤程度、患者3年预后结局差异。结果:经过联合放化疗，观察组治疗有效率显著高于对照组（98.18% vs 88.10%, P<0.05）。放疗过程中，观察组小肠、膀胱、直肠接受放疗的平均受照射剂量、2.0 cm3受照射剂量均显著低于对照组（P<0.05），观察组骨髓抑制、放射性直肠炎、放射性膀胱炎的发生程度均显著低于对照组（P<0.05）；随访3年，两组生存率无统计学差异（P>0.05），观察组患者3年的中位生存时间长于对照组（P<0.05）。结论:CT引导下三维腔内后装放疗联合IMRT、顺铂治疗晚期宫颈癌的效果优于二维腔内后装放疗联合IMRT、顺铂治疗，对危及器官的放射性损伤程度更低，患者的生存时间更长。

Clinical outcome of CT-guided three-dimensional intracavitary brachytherapy combined with intensity-modulated radiotherapy for advanced cervical cancer

Abstract: Objective To investigate the clinical outcome in advanced cervical cancer patients treated with CT-guided three-dimensional intracavitary brachytherapy combined with intensity-modulated radiotherapy (IMRT) and cisplatin chemotherapy. Methods Among 97 advanced cervical cancer patients selected for retrospective analysis, 55 patients received CT-guided three-dimensional intracavity brachytherapy combined with IMRT and cisplatin chemotherapy (observation group), and the other 42 patients were treated with two-dimensional intracavitary brachytherapy combined with IMRT and cisplatin chemotherapy (control group). The treatment outcome, radiation damage to organs-at-risk, and 3-year prognostic outcomes were compared between two groups. Results After radiochemotherapy, the proportion of CR+PR patients in observation group was 98.18%, higher than 88.10% in control group (P<0.05). The average radiation dose and 2.0 cm3 radiation dose to the small intestine, bladder and rectum were significantly lower in observation group than in control group (P<0.05), and the incidences of myelosuppression, radiation proctitis and radiation cystitis in observation group were significantly lower than those in control group (P<0.05). After 3 years of follow-up, the survival rate in observation group was close to that of control group (P>0.05), but the 3-year median survival time in observation group was longer than that in control group (P<0.05). Conclusion CT-guided three-dimensional intracavity brachytherapy combined with IMRT and cisplatin chemotherapy is more effective than two-dimensional intracavity brachytherapy combined with IMRT and cisplatin chemotherapy, with less radiation damage to organs-at-risk and longer survival time.