CT 引导的插植近距离治疗联合容积调强弧形治疗在宫颈癌患者中疗效及安全性分析

目的:探讨插植近距离治疗与常规球管联合近距离治疗在宫颈癌中的疗效与毒副作用。方法:100例初治Ⅱa-Ⅳ期宫颈鳞状细胞癌患者经容积调强弧形放射治疗联合CT引导的近距离治疗，根据后装治疗时施源器分为组织间插植组52例，常规球管联合组48例。两组均开始于全部盆腔外照射(剂量为50.4 Gy)结束后。结果:放疗结束后，插植组与常规球管联合组的局部有效率，3个月为94.23%(49/52) vs 95.83%（46/48），6个月为88.46%（46/52） vs 77.08%（37/48），1年为71.15%(37/52) vs 54.17%（26/48）；无进展生存时间分别为21.94个月和 14.33个月；截止至患者死亡或者随访时间终点总生存时间分别为37.8个月和20.16个月。依据肿瘤分期分层比较，插植组总生存均高于常规球管联合组（P＜0.05），其余年龄、肿瘤大小及分化程度分层比较可见插植组总生存时间也高于常规球管联合组，但差异无统计学意义。按美国肿瘤放疗协作组（Radiation-therapy Oncology Group，RTOG）急性期及晚期放射反应评分标准，常见的不良反应为放射性直肠炎、放射性膀胱炎及骨髓抑制，插植组发生率明显低于常规球管联合组（P＜0.05）。结论:CT引导的组织间插植近距离治疗联合容积调强弧形治疗在宫颈癌患者中，可以在减轻宫颈癌放疗副作用的同时提高宫颈癌的治疗效果，值得临床推广应用。

Efficacy and safety of the CT-guided implantation brachytherapy combined with volume-modulated arc therapy in patients with cervical cancer

Objective:To evaluate the efficacy and adverse effects of patients with cervical cancer treated by implantation brachytherapy or the fixed three tube applicator brachytherapy.Methods:One hundred patients with stage Ⅱa-Ⅳ stage cervical squamous-cell carcinoma were treated with CT-guided brachytherapy combined with volume-modulated arc therapy.After the DT 50.4 Gy of the external radiation,they were randomly allocated into two groups according to the different brachytheraputic modality:The implantation therapy group (52 patients) and fixed three tube applicator group (48 patients).Results:After the radiotherapy,the local effective rate in the implantation group was 94.23% (49/52) and 95.83% (46/48) at 3 months,88.46% (46/52) and 77.08% (37/48) at 6 months,71.15% (37/52) and 54.17% (26/48) at 1 year.The progression-free survival of two groups were 21.94 months and 14.33 months,respectively.The overall survival were 37.8 months and 20.16 months.In different tumor stages,the overall survival of the interpolation group was higher than that of the conventional tubulization group (both P＜0.05).According to Radiation Therapy Oncology Group (RTOG) acute and late radiation reaction evaluation criterion,the adverse reactions included radiation induced rectitis,radiation induced cystitis,and hematological toxicities.The adverse reactions incidence rate in interpolation group was lower than that in conventional tubulization group (P＜0.05).Conclusion:CT-guided interstitial implantation brachytherapy combined with volume-modulated arc therapy in cervical cancer patients can reduce the side effects of radiotherapy of cervical cancer and improve the therapeutic effect of cervical cancer,which is worthy of clinical application and promotion.