252Cf中子腔内照射加全盆腔外照射治疗子宫内膜癌的临床观察

目的观察^252Cf中子腔内照射加全盆腔外照射治疗子宫内膜癌的3年局部控制率、生存率、远期并发症以及预后影响因素。方法选择40例未接受过任何治疗,按照国际妇产科联盟（FIGO）1971年临床分期标准诊断为临床Ⅰb-Ⅳa期的子宫内膜癌患者作为研究对象。其中,Ⅰb期15例,Ⅱ期15例,Ⅲ期8例,Ⅳa期2例;腺癌30例,腺鳞癌6例,乳头状腺癌4例;G1 25例,G2-G3 15例。治疗方案：^252Cf中子腔内照射,A点总剂量为35—45Gy（i）,F点总剂量为38—50Gy（i）。治疗间歇穿插全盆腔外照射,前后对穿野,外照射剂量达20—30Gy后,盆腔野中央屏蔽挡铅4cm,四野外照射治疗,使总剂量达到45—50Gy,总疗程5—6周。患者均随访36个月以上。结果患者的3年局部控制率为88％（35／40）,总生存率为75％（30／40）。其中,Ib期3年局部控制率为93％（14／15）,总生存率为87％（13／15）,虽高于Ⅱ期患者的80％（12／15）和87％（13／15）,但差异无统计学意义（P〉0．05）;明显高于Ⅲ-Ⅳ期的60％（6／10）和50％（5／10）,差异有统计学意义（P〈0．01）。G1患者的3年局部控制率为92％（23／25）,总生存率为88％（22／25）,明显高于G2-G3患者的80％（12／15）和53％（8／15）,差异有统计学意义（P〈0．01）。腺癌患者的3年局部控制率为93％（28／30）,总生存率为87％（26／30）,明显高于腺鳞癌及乳头状腺癌的70％（7／10）和30％（3／10）,差异有统计学意义（P〈0．01）。所有患者Ⅱ级以上远期放射性膀胱炎的发生率为2％（1／40）,Ⅱ级以上远期放射性直肠炎和乙状结肠炎的发生率为10％（4／40）。结论^252Cf中子腔内照射加全盆腔外照射治疗子宫内膜癌具有较好的临床应用前景。子宫内膜癌的临床分期、病理类型和病理分级是重要的预后影响因素。

Follow-up study of clinical effects of californium-252 neutron intracavitary radiotherapy and external beam radiotherapy in endometrial cancer

OBJECTIVE: To observe the three year local control rate, overall survival rate, complications and prognostic factors of endometrial cancer treated with (252)Cf neutron intracavitary brachytherapy (ICBT) and external beam radiotherapy (EBRT). METHODS: Forty endometrial cancer patients staged Ib - IVa by the standard of Federation of International Gynecologic Organization (FIGO), who had not received any treatment were enrolled in this study. Treatment schedules were: (252)Cf ICBT, 10 - 13 Gy(i)/fraction per week, the total dose to point A and point F 35 - 45 Gy(i) and 38 - 50 Gy(i) respectively in 4 fractions. The EBRT was given to the whole pelvic field, with 6 MV or 8 MV X-ray, 2 Gy per fraction, 4 times per week. The total dose was 45 to 50 Gy (the field was blocked 4 cm after 20 - 30 Gy), the total treatment time was 5 - 6 weeks. RESULTS: The follow-up time was 36 - 96 months, with an average of 42 months. The three year local control and overall survival rate was 88% (35/40) and 75% (30/40) respectively for all patients. Of those patients of stage Ib, they were 93% (14/15) and 87% (13/15), respectively, higher than stage II [80% (12/15), 87% (13/15); P > 0.05], significantly higher than stage III, IV [60% (6/10), 50% (5/10); P < 0.01]. Three year local control and overall survival rate of G(1) grade was 92% (23/25) and 88% (22/25) respectively, significantly higher than G(2) - G(3) grade [80% (12/15), 53% (8/15); P < 0.01]. Three year local control and overall survival rate of adenocarcinoma was 93% (28/30) and 87% (26/30) respectively, significantly higher than squamous adenocarcinoma and papillary adenocarcinoma [70% (7/10), 30% (3/10); P < 0.01]. The grade 2 late radiation cystitis was 2% (1/40), and grade 2, 3 radiation proctitis and sigmoiditis were 10% (4/40). CONCLUSIONS: Combined (252)Cf ICBT and EBRT may be safe and effective for advanced endometrial cancer. The most important prognostic factors were stage, pathological type and differentiation of endometrial cancer.