非根治剂量的体外照射配合腔内放疗加根治术治疗宫颈癌

目的 总结分析外照射配合腔内放疗加根治术治疗Ⅰb-Ⅲa期宫期癌的5年生存率和晚期并发症。方法 106例宫颈癌均行广泛性子宫切除和盆腔淋巴结清除术,其中78例行术前放疗（体外加腔内放疗,下同）,16例采用腔内放疗＋手术,12例术后放疗。外照射采用^60Co治疗机,给予合盆或盆腔四野照射,B点剂量术前放疗者为25－30Gy,术后放疗者为40－50Gy;腔内放疗采用^192Ir高剂量率后装机,A点剂量6－18Gy。结果 （1）5年生存率：Ⅰb-Ⅲa期术前放疗组为78.2%（61／78）,腔内＋手术组为68.8%（11／16）,术后放疗组为33.3%（4／12）。术前放疗组与术后放疗组相比,差异有显著性（P＜0.05）。术前放疗组中,Ⅱ期患者的5年生存率(77.6%,45／58）高于术后放疗组（1／4,P＜0.05）。（2）主要并发症：多为放射性直肠炎和膀胱炎。术前放疗组、腔内放疗＋手术组和术后放疗组的并发症发生率分别为34.6%(27/78）、31.3%（5／16）和33.3%(4/12),差异无显著性（P＞0.05）。结论 非根治量的体外照射配合腔内放疗加根治术治疗宫颈癌,可提高Ⅰb-Ⅲa期患者总的5年生存率和Ⅱ期患者的5年生存率,晚期并发症发生率差异无显著性。

Combination of subradical external radiation and brachytherapy plus radical operation in the treatment of carcinoma of uterine cervix

OBJECTIVE: To summarize retrospectively the 5-year survival rates and long-term complication of stage Ib-IIIa cervical carcinoma treated by combination of subradical external radiation and brachytherapy plus radical operation. METHODS: 106 patients with cervical carcinoma were all treated by radical hysterectomy and pelvic lymphadenectomy, of whom 78 had had preoperative radiotherapy (external radiation and brachytherapy), 16 combination of brachytherapy and radical operation, 12 adjuvant postoperative radiotherapy (external radiation and brachytherapy). (60)Co was used for external radiation, in which the point B dose was 25 - 30 Gy in preoperative radiation and 40 - 50 Gy in postoperative radiation. (192)Ir high-dose-rate afterloading unit was used in brachytherapy, with a dose of 6 - 18 Gy at point A. RESULTS: The follow up rate was 95.3%. The overall 5-year survival rates were 78.2% (61/78) in the preoperative radiotherapy group, 68.8% (11/16) in brachytherapy plus radical operation, 33.3% (4/12) in the postoperative radiotherapy group, showing a higher 5-year survival rate in the preoperative radiotherapy group than the postoperative radiotherapy group (P < 0.05). In stage II patients, the preoperative radiotherapy group -77.6% (45/58) also gave a higher survival than the postoperative radiotherapy group -25.0% (1/4) (P < 0.05). But all the other groups gave differences of insignificance. The chief long-term complications were radio-proctitis and cystitis, with incidences of 34.6% (27/78), 31.3% (5/16), 33.3% (4/12) in the preoperative radiotherapy group, brachytherapy plus radical operation group and the postoperative radiotherapy group (P > 0.05). CONCLUSION: The overall 5-year survival rate of combined subradical external radiation and brachytherapy plus radical operation was obviously higher than that of postoperative radiotherapy for stage Ib-IIIa and II patients, with statistically significant differences. However, the incidence of long-term complications give no statistical significance in the preoperative radiotherapy group or brachytherapy plus the operation group as compared with the postoperative radiotherapy group.