盆腔野加后程三维适形放射治疗中晚期宫颈癌临床研究

目的探讨盆腔野加后程三维适形放射治疗（3DCRT）不能手术的中晚期宫颈癌临床疗效及副反应。方法60例不能手术的Ⅱb、Ⅲ期宫颈癌患者先采用模拟机定位，盆腔野前后二野（16-18）cm×（15—17）cm对穿照射，1．8—2Gy／次，5次／周，照射剂量46—50Gy；然后采用CT模拟定位，勾画GTV（肿瘤靶区）和CTV（临床靶区）及周围敏感器官，设4—6个野等中心照射，2—2．5Gy／次，5次／周，照射剂量24—30Gy，总剂量70-78Gy。结果总有效率（CR＋PR）为91．67％（55／60），其中CR55．0％（33／60），PR36．67％（22／60），SD8．33％（5／60）。1、2、3年生存率分别为93．33％（56／60）、83．30％（50／60）、76．67％（46／60），其中3年生存率Ⅱb期84．85％（28／33），Ⅲ期66．67％（18／27）。放疗早期反应：直肠反应发生率20％（12／60），膀胱反应18．33％（11／60），消化道反应26．67％（16／60），会阴部皮肤反应21．67％（13／60）。晚期并发症：放射性结直肠炎、放射性膀胱炎发生率均为8．33％（5／60），阴道挛缩黏连、宫腔积液均为5％（3／60），早晚反应均为Ⅰ-Ⅱ级。结论采用盆腔野加后程三维适形放射治疗对中晚期宫颈癌有较好的局控率与生存率，毒副反应轻，患者易耐受，且操作易行，照射时间及治疗周期短，尤其适合无法进行腔内治疗患者，值得临床进一步研究、应用。

Clinical study of cervical carcinoma treated with 3DCRT plus pelvis radiotherapy

Objective To study clinical effects and side effects of middle and advanced cervical carcinoma treated with 3DCRT plus pelvis radiotherapy. Method For 60 patients with cervical cancer stage H and stage HI, using simulating localizer to radiate the whole pelvis 16 - 18cm × 15 - 17cm, 1.8 -2Gy per fraction, 5 fractions per week, and total dose was 46 -50Gy. Then using CT simulator to draw GTV and CTV, at the same time, to draw sensitive organs and set 4 to 6 fields, 2 -2.5Gy per fraction, 5 fraction per week, radiation dose was 24 -30Gy, and total dose was 70 -78Gy. Results Total efficiency （R ＋ PR） was 91.67% （55/60）, which included CR 55.0% （33/60） and PR 36.67% （22/60）, and SD 8.33% （5/60%）, total survival rate of 1,2 and 3 year was 93.33% （56/60）, 83.30 % （50/60） and 76.67% （46/60）, respectively. Which included total 3 years survival rate of stage Ⅱb was 84.85% （28/33） and of stage Ⅲ was 66.67% （18/27）. Acute complications were as follows： incidence of postradiation proctitos was 20% （12/60）, cystitis 18.33% （11/60）, side effects on digestive system was 26.67% （16/60）. The skin reaction of perineum was 21.67% （13/60）. Long- term complications were as follows： postradiation proctitis and cystisis was 8.33% （5/60）. Viginal stenosis, uterine hydropsand was 5% （3/60）. Conclusion It is a good method to treat middle and advanced cervical cancer with 3DCRT plus pelvis radiotherapy. It can be easily endured with its convenient operation, short- cycled irradiation and therapy; it is particularly suitable for patients who could not be treated by endovascular.