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目的探讨盆腔野加后程三维适形放射治疗(3DCRT)不能手术的中晚期宫颈癌临床疗效及副反应。方法60例不能手术的Ⅱb、Ⅲ期宫颈癌患者先采用模拟机定位,盆腔野前后二野(16-l8)cm×(15-17)cm对穿照射,1.8-2Gy/次,5次/周,照射剂量46-50Gy;然后采用CT模拟定位,勾画GTV(肿瘤靶区)和CTV(临床靶区)及周围敏感器官,设4-6个野等中心照射,2-2.5Gy/次,5次/周,照射剂量24-30Gy,总剂量70-78Gy。结果总有效率(CR+PR)为91.67%(55/60),其中CR 55.0%(33/60),PR 36.67%(22/60),SD 8.33%(5/60)。1、2、3年生存率分别为93.33%(56/60)、83.30%(50/60)、76.67%(46/60),其中3年生存率Ⅱb期84.85%(28/33),Ⅲ期66.67%(18/27)。放疗早期反应:直肠反应发生率20%(12/60),膀胱反应18.33%(11/60),消化道反应26.67%(16/60),会阴部皮肤反应21.67%(13/60)。晚期并发症:放射性结直肠炎、放射性膀胱炎发生率均为8.33%(5/60),阴道挛缩黏连、宫腔积液均为5%(3/60),早晚反应均为Ⅰ-Ⅱ级。结论采用盆腔野加后程三维适形放射治疗对中晚期宫颈癌有较好的局控率与生存率,毒副反应轻,患者易耐受,且操作易行,照射时间及治疗周期短,尤其适合无法进行腔内治疗患者,值得临床进一步研究、应用。
Objective To investigate the clinical effects and side effects of pelvic cavity plus posterior three-dimensional conformal radiotherapy (3DCRT) inoperable advanced cervical cancer. Methods Sixty patients with unresectable stage IIb and III cervical cancer were treated with simulator. The pelvic anteroposterior and lateral ventricles (16-l8 cm × (15-17) cm) were exposed to radiation, 1.8-2 Gy / time and 5 times / Weeks, irradiation dose 46-50Gy; then using CT simulation positioning, outlined GTV (tumor target area) and CTV (clinical target area) and the surrounding sensitive organs, set 4-6 wild center irradiation, 2-2.5Gy / time, 5 times / week, radiation dose 24-30Gy, the total dose of 70-78Gy. Results The total effective rate (CR + PR) was 91.67% (55/60), of which CR was 55.0% (33/60), PR 36.67% (22/60) and SD 8.33% (5/60). The 1-year, 2-year and 3-year survival rates were 93.33% (56/60), 83.30% (50/60) and 76.67% (46/60), respectively. The 3-year survival rates were 84.85% (28/33) Period 66.67% (18/27). Early response to radiotherapy: The incidence of rectal reaction was 20% (12/60), bladder reaction 18.33% (11/60), digestive tract reaction 26.67% (16/60) and perineal skin reaction 21.67% (13/60). Late complications: Radiation proctitis, incidence of radioactive cystitis were 8.33% (5/60), vaginal contracture adhesions, uterine effusion were 5% (3/60), sooner or later the reaction was Ⅰ-Ⅱ level. Conclusions The three-dimensional conformal radiation therapy with pelvic field and post-treatment has better local control rate and survival rate for advanced cervical cancer. The toxicities and side effects are mild, the patients are easy to tolerate, the operation is easy, the irradiation time and treatment cycle are short, Particularly suitable for patients who can not be treated in the cavity, it is worth further clinical study and application.