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目的比较中晚期宫颈癌癌超分割三维一体化放疗与常规腔内后装治疗的临床疗效。方法随机选取180例初治中晚期宫颈癌患者分成超分割三维一体化组89例(IIB 42例,ⅢB 47例)和常规放疗组91例(IIB 43例,ⅢB 48例),两组均采用同步放化疗,外照射全盆腔剂量10 Gy~30Gy后,开始配合腔内近距离治疗,均采用192Ir高剂量率后装治疗机,腔内照射当天不做体外照射。腔内放疗超分割组:IIB~ⅢB期A点剂量2.5~3.0Gy,F点剂量为A点的1/2~1/3,2次/d,治疗间隔大于6h,A点总剂量达42Gy~50Gy;腔内放疗常规分割组:IIB~ⅢB期A点剂量5.0~6.0Gy,F点剂量为A点的1/2~1/3,每周治疗1次,A点总剂量42Gy~50Gy,腔内治疗当天不做体外照射。结果三维一体化超分割组近期生存率(97.8%)有高于常规后装治疗组(94.2%)的趋势,但差异无统计学意义(P>0.05)。结论与常规后装治疗组相比,超分割三维一体化放疗组近期疗效相同,直肠损伤、远期生存率尚有待进一步随访及评诂。
Objective To compare the clinical efficacy of hyperfractionated three-dimensional radiotherapy and conventional endovascular treatment of advanced cervical cancer. Methods One hundred and eighty patients with newly diagnosed middle and advanced cervical cancer were randomly divided into three groups: 89 cases (42 cases of IIB, 47 cases of IIIB) and 91 cases of conventional radiotherapy (43 cases of IIB and 48 cases of IIIB) Concurrent chemoradiation and external irradiation of the whole pelvis dose of 10 Gy ~ 30Gy, began with intracavitary brachytherapy, using 192Ir high dose rate afterloading treatment machine, intraluminal irradiation the same day without external irradiation. In the endovascular radiotherapy group, the dose was 2.5-3.0 Gy at point A of stage IIB-IIIB, 1/2 to 1/3, 2 times / d of point A, and the treatment interval was more than 6 hours. The total dose of point A was 42 Gy ~ 50Gy; conventional radiotherapy group: IIB ~ ⅢB A dose of 5.0 ~ 6.0Gy, F dose of point A of 1/2 ~ 1/3, once a week treatment, A total dose of 42Gy ~ 50Gy On the day of endovascular treatment, no external irradiation was performed. Results The recent survival rate (97.8%) in the three-dimensional integrated hyperfractionation group was higher than that in the conventional post-treatment group (94.2%), but the difference was not statistically significant (P> 0.05). Conclusion Compared with the conventional afterloading treatment group, the ultrafractionated three-dimensional integrated radiotherapy group has the same short-term curative effect. The rectal injury and long-term survival rate are yet to be followed up and evaluated.