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目的:探讨宫颈癌根治性放疗后发生重度慢性放射性直肠炎(SLRT,放射性直肠炎≥3度)的可能因素。方法:收集211例行根治性放疗的宫颈癌患者的临床资料,SPSS 17.0进行统计学分析。结果:18例患者出现SLRT,193例未出现SLRT(NSLRT)。SLRT组与NSLRT组患者3年生存率无明显统计学差异(P>0.05)。单因素和多因素分析示直肠点相当于2Gy分次的生物等效剂量EQD2_R和急性放射性直肠炎(ART)的严重程度是SLRT发生的危险因素(P<0.05)。受试者工作特征(ROC)曲线示EQD2_R引起SLRT的最佳界值为74.3 Gy_3(早反应组织α/β=10,晚反应组织α/β=3),曲线下面积为0.983;ART引起SLRT的最佳界值为2度,曲线下面积为0.892。结论:EQD2_R和ART是SLRT发生的危险因素。宫颈癌根治性放疗时,推荐EQD2_R<74.3 GY_3,并积极治疗ART≥2度者,以减少SLRT的发生。
Objective: To investigate the possible causes of severe chronic radiation proctitis (SLRT, radiation proctitis≥3 degrees) after radical radiotherapy of cervical cancer. Methods: The clinical data of 211 patients with cervical cancer undergoing radical radiotherapy were collected and analyzed by SPSS 17.0. RESULTS: Eighteen patients had SLRT and 193 had no SLRT (NSLRT). There was no significant difference in 3-year survival rate between SLRT group and NSLRT group (P> 0.05). Univariate and multivariate analyzes showed that the bioequivalent doses of EQD2_R and acute radiation proctitis (ART) at the site of the rectum corresponded to 2Gy were the risk factors for SLRT (P <0.05). The receiver operating characteristic (ROC) curve showed that the best cutoff value of EQD2_R for SLRT was 74.3 Gy_3 (α / β = 10 in early reaction and α / β = 3 in late reaction), and the area under the curve was 0.983. The best cutoff is 2 degrees and the area under the curve is 0.892. Conclusion: EQD2_R and ART are risk factors for SLRT. Cervical cancer radical radiotherapy, recommended EQD2_R <74.3 GY_3, and active treatment of ART ≥ 2 degrees to reduce the incidence of SLRT.