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目的探讨巨块型宫颈癌根治术前高剂量率腔内近距离放疗(ICBT)的治疗效果。方法对200001-200412中山大学附属肿瘤医院和附属第二医院收治的51例ⅠB2～ⅡB期巨块型宫颈癌根治术前采用ICBT,对患者的局部肿瘤缓解情况、毒副反应、手术情况及高危病理因素进行回顾性分析;与同期直接接受根治术的同期别56例巨块型宫颈癌比较。结果施行ICBT后,宫颈肿瘤临床完全缓解5.9%(3/51),部分缓解51.0%(26/51),无变化43.1%(22/51),恶化0。并发症发生率较低,主要是骨髓抑制、腹泻、放射性直肠炎和膀胱炎。全部患者均按宫颈癌根治术规范完成。ICBT组较直接手术组手术时间缩短(3.58±1.08)h对(4.46±0.93)h,术中出血量减少(395.1±219.8)mL对(999.1±637.4)mL,术后拔尿管时间缩短(11.47±6.48)d对(15.18±8.41)d,尿潴留的发生率减少(37.25%对48.2%)。除尿潴留外,两组比较差异均有显著性(P<0.05)。高危病理差异无显著性(P>0.05)。结论宫颈癌根治术前适当剂量腔内放疗是较早期巨块型宫颈癌较理想的治疗方案。
Objective To investigate the therapeutic effect of intracavitary brachytherapy (ICBT) at high dose before bulky cervical cancer. Methods ICBT was performed in 51 cases of stage ⅠB2 ~ ⅡB giant cervical carcinoma treated at the Affiliated Tumor Hospital and the Second Affiliated Hospital of Sun Yat-sen University from 200001 to 200412. The local tumor remission, side effects, operative conditions and high risk Pathological factors were retrospectively analyzed; with the same period directly underwent radical surgery in the same period 56 cases of massive cervical cancer compared. Results After ICBT, cervical cancer was completely relieved by 5.9% (3/51), partially relieved by 51.0% (26/51), unchanged by 43.1% (22/51) and deteriorated by 0%. The incidence of complications is low, mainly myelosuppression, diarrhea, radiation proctitis and cystitis. All patients according to the standardization of cervical cancer to complete. Compared with the direct operation group, ICBT group had shorter operative time (3.58 ± 1.08) h vs (4.46 ± 0.93) h, less intraoperative blood loss (395.1 ± 219.8) mL vs (999.1 ± 637.4) mL, shorter postoperative catheterization time 11.47 ± 6.48) d versus (15.18 ± 8.41) d, the incidence of urinary retention decreased (37.25% versus 48.2%). In addition to urinary retention, the difference between the two groups was significant (P <0.05). High-risk pathological differences were not significant (P> 0.05). Conclusion The appropriate dose of intracavitary radiotherapy for radical resection of cervical cancer is an ideal treatment for earlier massive cervical cancer.