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目的采用非常规的腔内治疗分割方式,探讨其方法的可行性与临床生物剂量效应。方法体外放疗(ExRT)+HDR腔内放疗(ICRT):65例病人:①Ⅱb全盆腔DT40Gy/4W/20F,Ⅲb46Gy/4·6W/23F;②结束后挡铅(中央遮挡铅块5HVL,4cm宽)B点DT补量(12～16)Gy/(6～8)F/(1·2～1·6)W;③Ⅱb、ⅢbA点3·3Gy/次,2次/d,两次间隔≥6h,每周间隔3d重复治疗,总计6次/3d/1·5W,A点总量DT1980cGy;④挡铅后ExRT与ICRT交替进行。结果结束时局部疗效CR52例(80%),PR13例(20%),NC0例,PD0例。1年生存率93·8%(61/65)。阴道反应Ⅰ度40例(62%),Ⅱ度19例(30%),Ⅲ度6例(8%),无1例因反应而导致治疗非计划中断。结论该方法可行,近期疗效满意。HDR腔内后装治疗宫颈癌,提高疗效,减少晚期并发症的关键是应用足够的分割(包括次数及剂量),但晚反应组织损伤、远期生存率有待进一步随访及评诂。
Objective To investigate the feasibility of the method and the clinical biological dose effect by using unconventional endovascular treatment. Methods ExRT + ICRT: 65 patients: ①Ⅱb full pelvic DT40Gy / 4W / 20F, Ⅲb46Gy / 4 · 6W / 23F; ②blocking lead after the end (central block lead 5HVL, 4cm wide ) Point B DT Supplement (12-16) Gy / (6-8) F / (1-2.6) W; ③ IIb, IIIbA Point 3 · 3Gy / time, twice / d, twice interval ≥ 6h, repeat treatment every 3d intervals, a total of 6 times / 3d / 1 · 5W, A point total amount of DT1980cGy; ④ ExRT blockade lead and ICRT alternately. Results at the end of the local efficacy CR52 (80%), PR 13 cases (20%), NC0 cases, PD0 cases. The 1-year survival rate was 93.8% (61/65). Vaginal reactions in 40 cases (62%), 19 cases (30%) and 6 cases (8%) in grade Ⅲ, none of which resulted in the treatment of unplanned interruptions. Conclusion The method is feasible, the recent satisfactory results. HDR intracavitary treatment of cervical cancer after treatment to improve efficacy and reduce late complications is the key to the application of adequate segmentation (including the number and dose), but late response to tissue damage, long-term survival needs to be followed up and review.