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目的探讨调强放射治疗(IMRT)在无淋巴结转移中晚期宫颈癌患者放疗中的临床应用价值。方法选取2007年6月至2008年12于哈尔滨医科大学附属第三医院行放射治疗的无淋巴结转移中晚期宫颈癌患者35例,其中IMRT组15例,常规放疗(CRT)组20例,观察两组患者的近期疗效及放疗反应的发生率。结果 IMRT组与CRT组近期总有效率(完全缓解+部分缓解)分别为86.7%、75.0%,差异无统计学意义(P>0.05)。IMRT组1、2年生存率分别为86.7%、60.0%,CRT组1、2年生存率分别为80.0%、50.0%,差异无统计学意义(P>0.05)。近期胃肠道及泌尿系放疗反应IMRT组发生率明显低于CRT组(P<0.05);骨髓抑制发生率两组差异无统计学意义(P>0.05);两组均未出现严重的Ⅲ、Ⅳ级胃肠反应及泌尿系反应。远期放射性直肠炎、膀胱炎、肠梗阻、盆腔及腹壁纤维化发生率IMRT组分别为20.0%、6.7%、6.7%和6.7%,均低于CRT组(P<0.05)。阴道粘连发生率两组差异无统计学意义(P>0.05)。结论在无淋巴结转移中晚期宫颈癌患者放疗中,与常规放疗相比,IMRT未能改善近期生存率,但可明显降低急慢性放疗反应的发生率。
Objective To investigate the clinical value of IMRT in the radiotherapy of patients with advanced cervical cancer without lymph node metastasis. Methods From June 2007 to December 2008, 35 patients with advanced cervical cancer without lymph node metastasis underwent radiotherapy in the Third Affiliated Hospital of Harbin Medical University from June 2007 to December 2008, including 15 cases in IMRT group and 20 cases in conventional radiotherapy group. The short-term efficacy of the group of patients and the incidence of radiation response. Results The total effective rate (complete remission + partial remission) in the IMRT group and CRT group was 86.7% and 75.0% respectively, with no significant difference (P> 0.05). The 1-year and 2-year survival rates of IMRT group were 86.7% and 60.0%, respectively. The 1-year and 2-year survival rates of CRT group were 80.0% and 50.0% respectively, with no significant difference (P> 0.05). The recent incidence of gastrointestinal and urinary response to radiotherapy in IMRT group was significantly lower than that in CRT group (P <0.05). There was no significant difference in the incidence of bone marrow suppression between the two groups (P> 0.05) Ⅳ grade gastrointestinal reactions and urinary tract reactions. The incidences of long-term radiation proctitis, cystitis, intestinal obstruction, pelvic and abdominal fibrosis were 20.0%, 6.7%, 6.7% and 6.7% in IMRT group, which were lower than CRT group (P <0.05). The incidence of vaginal adhesions was no significant difference between the two groups (P> 0.05). Conclusion IMRT failed to improve the short-term survival rate compared with conventional radiotherapy in patients with advanced cervical cancer without lymph node metastasis, but could significantly reduce the incidence of acute and chronic radiotherapy.