IMRT同步剂量补偿高剂量率后装治疗大体积宫颈癌的疗效分析

目的 探讨IMRT同步剂量补偿高剂量率后装治疗方法在局部晚期宫颈癌治疗中的价值。方法 2010-2015年四川省肿瘤医院病理诊断明确的120例肿瘤最大径≥6 cm或最大径≥5 cm且肿瘤呈偏心性生长的宫颈癌患者接受盆腔外放疗,之后予以后装联合同步IMRT剂量补偿同步顺铂化疗。IMRT 45 Gy分25次,后装联合同步IMRT剂量补偿HR-CTV 7 Gy/次、IR-CTV 5~6 Gy/次,共5次;危及器官勾画直肠、乙状结肠、膀胱及毗邻小肠。所有入组患者均接受以顺铂75 mg/m² ,每3周1次为基础同步化疗。结果 全组患者随访14~96个月(中位数46个月)。5年局部控制、无进展生存、总生存率分别为92.8%、76.6%、81.0%。胃肠道、泌尿生殖系统急性1-2级早期不良反应分别为57.8%、14.6%,3级分别为8.1%、2.9%;晚期1-2级不良反应分别为8.4%、5.3%,3级分别为0.97%、1.3%。结论 IMRT联合同步剂量补偿HDR-ICBT方法治疗局部晚期宫颈癌严重不良反应发生率低,且具有较好的局部控制率和总生存率,是肿瘤体积较大的局部晚期宫颈癌患者综合治疗的有效方法。

Clinical efficacy of HDR brachytherapy with concomitant complementary IMRT boost for bulky uterine cervical cancer

Objective To investigate the clinical outcomes of patients with locally advanced uterine cervical cancer (UCC) treated by 3-dimensional high dose rate-intracavitary brachytherapy (3D HDR-ICBT) combined with complementary applicator-guided external beam radiotherapy (EBRT). Methods A total of 120 patients pathologically diagnosed with locally advanced UCC (tumors with a maximum diameter≥6 cm or≥5 cm complicated with eccentric tumor growth) treated with concurrent chemoradiotherapy (CCRT) from June 2010 to June 2015 were recruited. Five fractions of 3D HDR-ICBT combined with complementary applicator-guided external beam radiotherapy were performed. The prescribed dose for HR-CTV and IR-CTV was 7 Gy(D90) and 5-6 Gy(D90). The rectum, sigmoid colon, bladder and adjacent small intestine were delineated as the organs at risk. Intensity-modulated radiation therapy (IMRT) was used for EBRT (45 Gy/25f) combined with cisplatin-based chemotherapy every three weeks (75 mg/m²). Results The median follow-up time was 46 months (14-96 months). The 5-year local control rate (LCR),disease-free survival (DFS),and overall survival (OS) were 92.8%,76.6% and 81.0%,respectively. The incidence rate of grade I-Ⅱ genitourinary and gastrointestinal acute toxicities were 57.8% and 14.6%, whereas 8.1% and 2.9% for grade Ⅲ toxicities. The incidence rate of later grade Ⅰ-Ⅱ genitourinary and gastrointestinal toxicities were 8.4% and 5.3%, and 0.97% and 1.3% for grade Ⅲ late toxicities. Conclusions The combination of HDR-ICBT with an applicator-guided IMRT (ICBT+IMRT) yields low incidence of severe adverse events, relatively high LC and OS rate for locally advanced UCC. It is an efficacious comprehensive treatment of locally advanced bulky UCC.