【摘要】 目的探讨腔内联合宫旁插植治疗(IC/ISBT)和腔内后装治疗(ICBT)对局部晚期宫颈癌的临床疗效。方法选取经体外照射放疗(50 Gy/25 f)后肿瘤消退不明显且宫旁受侵的局部晚期(ⅡB～ⅢB期)宫颈癌患者100例。采用随机数字表法将患者分为ICBT组和IC/ISBT组,每组50例。然后进行CT,将图像传至Oncentra Brachy Therapy计划系统,行靶区勾画,采用模拟退火逆向优化方式进行计划设计,比较ICBT组和IC/ISBT组患者的近期疗效、肿瘤复发或转移率、并发症发生率。结果 IC/ISBT组患者的完全缓解(CR)率为96.0%,高于ICBT组的88.0%,差异有统计学意义(P﹤0.05);IC/ISBT组患者的客观缓解率(ORR)为98.0%,高于ICBT组的92.0%,差异有统计学意义(P﹤0.05)。IC/ISBT组患者的肿瘤复发或转移率为4.0%,低于ICBT组的16.0%,差异有统计学意义(P﹤0.05)。IC/ISBT组患者放射性皮炎的发生率为38.0%,与ICBT组的42.0%比较,差异无统计学意义(P﹥0.05);IC/ISBT组患者放射性直肠炎的发生率为14.0%,低于ICBT组的32.0%,差异有统计学意义(P﹤0.05);IC/ISBT组患者放射性膀胱炎的发生率为30.0%,与ICBT组的28.0%比较,差异无统计学意义(P﹥0.05)。结论对外照射后肿瘤消退不明显、宫旁受侵的局部晚期宫颈癌患者采用IC/ISBT治疗方式,可取得较好的宫旁控制率和近期疗效,且能够降低放射性直肠炎的发生率,值得临床推广应用。更多还原

【Abstract】 Objective To explore the clinical efficacy of intracavitary and para-cercix interstitial brachytherapy(IC/ISBT) and intracavitary brachytherapy(ICBT) in the treatment of local intermediate and advanced cervical cancer.Method 100 patients with local intermediate and advanced cervical cancer(stage IIB-IIIB) who underwent external beam radiation therapy(EBRT)(50 Gy/25 f) with no obvious tumor regression and with paracervical invasion were included and randomly divided into the ICBT group(n=50) and IC/ISBT group(n=50). Images were transfered to Oncentra Brachy Therapy planning system after CT scanning. The target area was delineated, the planned design was conducted by using inverse planning simulated annealing(IPSA), the short-term efficacy, tumor recurrence/metastasis rate and incidence of adverse reactions between ICBT group and IC/ISBT group were compared. Result The complete response(CR) rate and objective response rate(ORR) in IC/ISBT group were higher than those in the ICBT group(96.0% vs88.0%, 98.0% vs 92.0%, P<0.05). The tumor recurrence/metastasis rate in the IC/ISBT group was lower than that in the ICBT group(4.0% vs 16.0%, P<0.05). There was no significant difference for incidence of radioactive dermatitis between IC/ISBT group and ICBT group(38.0% vs 42.0%, P>0.05). The incidence of radioactive proctitis in the IC/ISBT group was lower than that in the ICBT group(14.0% vs 32.0%, P<0.05). There was no significant difference for the incidence of radioactive cystitis between IC/ISBT group and ICBT group(30.0% vs 28.0%, P>0.05). Conclusion For local intermediate and advanced cervical cancer patients with paracervical invasion but without obvious tumor regression after external radiation, IC/ISBT can provide better paracervical control rate and short-term efficacy and reduce the incidence of radiation proctitis. Therefore, it is worthy of clinical promotion and application.更多还原