252Cf中子腔内后装加盆腔外照射治疗子宫颈癌临床分析

目的观察^252Cf腔内后装加盆腔外照射治疗宫颈癌的疗效以及晚期并发症的发生情况,并对治疗方案进行总结。方法选择77例未接受过任何治疗的临床分期为Ⅱa～Ⅳa期的宫颈癌患者作为研究对象,其中Ⅱa期13例,Ⅱb期32例,Ⅲa期18例,Ⅲb期10例,Ⅳa期4例。治疗方案：^252Cf中子腔内后装治疗,宫旁A点剂量为8～11Gy／次,1次／周,共进行4～5次,使宫旁A点累积剂量达36～45Gy;该治疗过程中,间歇穿插前后对穿野全盆腔外照射200cGy／次,4次／周;外照射20—36Gy后,盆腔野中央屏蔽挡铅4cm,继续四野外照射200cGy／次,4次／周,使盆腔外照射总剂量达到45～50Gy左右。总疗程约需5—6周。结果77例患者随访3年,3年局部控制率为94％(72／77);3年总生存率为82％(63／77),其中临床分期Ⅱa期为85％(11／13),Ⅱb期为94％(30／32),Ⅲa期为78％(14／18),Ⅲb期为70％(7／10),Ⅳa期为1／4。放射性膀胱炎发生率为3％,放射性直肠炎发生率为5％。结论^252Cf中子腔内后装加盆腔外照射治疗宫颈癌,患者能较好耐受,且其Ⅱ、Ⅲ期患者的3年生存率较高而并发症发生率较低,具有较好的应用前景。

Combination of external beam radiotherapy and 252Cf neutron intracavitary brachytherapy for cervical cancer

OBJECTIVE: To evaluate the curative effect of 252Cf brachytherapy on advanced cervical cancers. METHODS: A total of 77 cervical cancer patients were staged into IIa-IVa according to the standard of International Federation of Gynecology and Obstetrics (FIGO), including 13 cases of stage IIa, 32 of stage IIb, 18 of stage IIIa, 10 of stage IIIb, and 4 of stage IVa. 252Cf brachytherapy was delivered at 8-11 Gy/fraction per week, the total dose of reference point A was 36-45 Gy in 4-5 fractions. The whole pelvic cavity was irradiated with 6 MV X-ray, 200 cGy/fraction, 4 times per week. The total dose of external beam radiotherapy was 45-50 Gy (the center of whole pelvic field was blocked by 4 cm in width after 20-36 Gy), the total treatment course was 5-6 weeks. The 3-year survival rate and late complication rate in bladder and rectum were evaluated. RESULTS: The local control rate of all patients after 3-year was 94% (72/77); the overall survival rate was 82% (63/77). In particular, the 3-year survival rate was 85% (11/13) for stage IIa, 94% (30/32) for stage IIb, 78% (14/18) for stage IIIa, 70% (7/10) for stage IIIb, 25% for stage IVa cancers. The late complication rate was 3% for cystitis, 5% for proctitis. CONCLUSIONS: Combination of 252Cf brachytherapy and external beam radiotherapy can be well-tolerated by cervical cancer patients. The 3-year survival rate for stage II and III patients is high and late complication rate in bladder and rectum is low.