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目的评价局部晚期宫颈癌调强放射治疗过程中更改调强放射治疗计划对肿瘤局部控制以及直肠、膀胱等危及器官放射性不良反应的影响,探讨该治疗模式的疗效及安全性。方法收集2011年8月至2012年10月间收治的50例采用调强放射治疗联合同期化疗的IIA2~ⅣA期宫颈鳞状细胞癌患者。调强放射治疗外照射总处方剂量:盆腔转移淋巴结(PGTVnd)60.2Gy2.15Gy/次;宫颈原发病灶(PGTV)54.04Gy,1.93Gy/次,共28次;盆腔淋巴结引流区(PTV)50.12Gy,1.79Gy/次,共28次;每天1次,每周5次。随机抽取25例患者(B组)外照射15次后重新进行CT定位、勾画靶区和制定放射治疗计划;另外25例患者(A组)放射治疗外照射放射治疗计划不做调整。放射治疗期间予顺铂单药每周35~40mg/m2,共6周。放射治疗外照射15次后行腔内后装放射治疗。放射治疗结束时、放射治疗结束后3个月、6个月、12个月进行随访,评价两组患者局部控制率、远处转移率、直肠、膀胱不良反应情况。结果 50例患者均按计划完成放射治疗。A组和B组患者放射治疗结束、放射治疗结束3个月、6个月、12个月时盆腔肿瘤局部控制率(CR+PR)分别为100%、100%、100%、100%和100%、100%、96%、96%(2=0.109,P>0.05)。治疗期间,A组有6例患者出现2级放射性直肠反应,2例患者出现3级放射性直肠炎反应;B组有3例患者出现2级放射性直肠反应,1例患者出现3级放射性直肠反应。两组患者均无2级急性放射性膀胱反应发生(2=1.082,P>0.05)。放射治疗结束12个月时,A组共有8例出现晚期放射损伤,其中7例为放射性直肠炎,1例为2级放射性膀胱炎;B组有3例出现晚期放射损伤,均为放射性直肠炎,(2=5.16,P<0.05)。结论局部晚期宫颈癌患者在调强放射治疗过程中,适时调整放射治疗计划,可减轻危险器官直肠、膀胱的晚期放射损伤,但不降低肿瘤的局部控制率。
Objective To evaluate the effect of intensity-modulated radiation therapy (IMRT) program on local control of tumor and radioactive adverse reactions such as rectum and bladder in the treatment of locally advanced cervical cancer IMRT, and to evaluate the efficacy and safety of this therapy. Methods Fifty patients with cervical squamous cell carcinoma of stage IIA2 ~ ⅣA underwent combined intensity modulated radiation therapy and concurrent chemotherapy were collected from August 2011 to October 2012. IMRT total dose: 60.2 Gy.2.15 Gy in pelvic metastatic lymph nodes (PGTVnd); 54.04 Gy in primary cervical lesions (PGTV), 1.93 Gy / total in 28 cases; pelvic lymphatic drainage area (PTV) Gy, 1.79Gy / time, a total of 28 times; 1 day, 5 times a week. Twenty-five patients (group B) were randomly selected after 15 external exposures to re-locate the CT, outline the target area and develop a radiotherapy plan. The other 25 patients (group A) did not adjust the external beam radiotherapy program. During radiotherapy cisplatin monotherapy weekly 35 ~ 40mg / m2, a total of 6 weeks. Radiotherapy 15 times after the external radiation after the line cavity radiation therapy. Radiotherapy at the end of 3 months after radiation therapy, 6 months, 12 months were followed up to evaluate the two groups of patients with local control rate, distant metastasis rate, rectum, bladder adverse reactions. Results All 50 patients completed the scheduled radiotherapy. Radiotherapy was completed in patients in group A and group B, and the local control rates (CR + PR) of pelvic tumors were 100%, 100%, 100%, 100% and 100 at 6 months and 12 months after the end of radiotherapy %, 100%, 96%, 96% (2 = 0.109, P> 0.05). During treatment, 6 patients in group A had grade 2 radioactive rectal reaction, 2 patients had grade 3 radioactive proctitis, 2 patients had grade 2 radioactive rectal reaction in group B and 3 patients had grade 3 radioactive rectal reaction in group B. No grade 2 acute radioactive bladder reaction occurred in both groups (2 = 1.082, P> 0.05). At 12 months after the end of radiotherapy, there were 8 cases of late radiation injury in group A, including 7 cases of radiation proctitis and 1 case of 2 stage radiation cystitis. In group B, 3 cases of late radiation injury were all radiological proctitis , (2 = 5.16, P <0.05). Conclusions In the patients with locally advanced cervical cancer, adjusting the radiotherapy schedule in the course of IMRT can reduce the late radiation damage of the rectum and bladder of dangerous organs without reducing the local control rate of the tumor.