宫颈癌术后调强放疗同期化疗临床分析

目的 回顾分析宫颈癌术后患者调强放疗(IMRT)同期化疗的生存率、局部控制率及不良反应。
方法 2005-2009年宫颈癌术后病理至少有1项预后不良因素的 115例患者入组。盆腔IMRT 96例、扩大野 19例,临床靶体积中位剂量50.4 Gy分28次;阴道残段高剂量率内照射参考点位于阴道黏膜下0.5 cm,驻留1 cm或 1/2阴道长度,中位剂量为15 Gy;97例同期每周40 mg/m²顺铂化疗。
结果 所有患者均顺利完成治疗,随访率为94.8%。全组 2年和 3年总生存率分别为94.2%和86.0%、无瘤生存率分别为84.2%和76.7%、盆腔控制率分别为96.0%和87.8%;40例出现 3~4级骨髓抑制,1例出现3级急性直肠反应,无≥3级泌尿系反应。100例患者8周内完成放化疗,2例出现≥3级慢性直肠反应,3例患者出现下肢水肿。
结论 宫颈癌术后具有不良预后因素者术后IMRT同期化疗具有较好的局部控制率及较低的不良反应。

Clinical effect of concurrent chemotherapy and intensity-modulated radiotherapy in postoperative cervical cancer patients

Objective To investigate the survival rate, local control rate, and toxicity rate in postoperative cervical cancer patients who receive concurrent chemotherapy and intensity-modulated radiotherapy (IMRT) by retrospective analysis.
Methods From September 2005 to May 2009, 115 postoperative cervical cancer patients, who had at least one poor prognostic factor as evaluated by pathological examination, were included in the study. Of all the patients, 96 received IMRT to the whole pelvic cavity, and 19 extended-field IMRT. The clinical target volume received a median dose of 50.4 Gy/28 fractions in all patients. High-dose-rate vaginal cuff brachytherapy (0.5 cm below the vaginal mucosa) was performed at an active length of 1 cm or half of the vaginal length and a median dose of 15 Gy. Ninetypatients received chemotherapy with cisplatin (40 mg/m²) as well as IMRT on a weekly basis.
ResultsTreatment was completed successfully in all patients. The follow-up rate was 94.8%. In all the patients, the 2-and 3-year overall survival rates were 94.2% and 86.0%, with disease-free survival rates of 84.2% and 76.7% and pelvic control rates of 96.0% and 87.8%;40 patients developed grade 3—4 myelosuppression, 1 patient developed grade 3 acute rectal toxicity, and none developed grade ≥3 urinary toxicity. Of the 100 patients who finished radiotherapy and chemotherapy within 8 weeks, 2 developed grade ≥3 chronic rectal toxicity, and 3 developed lower extremity edema.
Conclusions The postoperative cervical cancer patients with poor prognostic factors who undergo postoperative concurrent chemotherapy and MRT can achieve high local control rate and low toxicity rate.