56例宫颈癌术后调强放射治疗(IMRT)的疗效观察

Clinical Observation on Intensity-Modulated Radiation Therapy (IMRT) in 56 Patients with Postoperative Cervical Cancer

摘要: 目的：回顾性分析宫颈癌术后IMRT治疗患者1、2、3年盆腔局部控制率、生存率及远期毒副反应。方法：回顾性分析2007年7月~2011年7月间贵州省肿瘤医院子宫颈癌根治术后具有术后放疗指征的患者56例，年龄在26~65岁之间(中位年龄42岁)，其中≥50岁患者22例，<50岁34例。FIGO分期为I期25例，II期31例；术后病理示鳞癌47例，腺癌9例。具有高危复发风险需补充术后放疗的因素包括：盆腔淋巴结阳性(21例)；宫旁侵犯(4例)；肿瘤侵犯浸润深度超过1/2 (20例)；脉管侵犯(11例)；56例患者放疗采用全盆IMRT，外照射DT50.4 Gy/28 f/5 W。术后满一个月行Ir¹⁹²近距离放疗，5 Gy/次/周，DT20 Gy。并行紫杉醇(135~175 mg/m²) + 顺铂(60~80 mg/m²)同期和/或同步化疗2~4个周期。随访3~36个月，总随访率为95%。结果：1年总生存率、盆腔局部控制率分别为100.0%、96.4%；2年总生存率、盆腔局部控制率分别为98.2%、96.4%，3年总生存率、盆腔局部控制率分别为94.6%、89.2%。淋巴结阳性及宫旁侵犯为影响总生存率的独立预后因素，分期、脉管侵犯为盆腔局部控制率的独立预后因素。按(RTOG)急慢性放射反应评价标准，远期直肠反应1级26.8%、2级8.9%、3级1.7%；远期泌尿系反应1级23.2%、2级5.3%、3级0%。远期血液学毒性1级41.1%、2级30.3%、3级8.9%。结论：宫颈癌术后IMRT治疗在盆腔局部控制率及总生存率上能达到较满意疗效，与多篇文献报道结果一致，且放疗相关远期毒副反应是可接受的。

Abstract: Objective: To retrospectively analyze IMRT treatment on partial pelvic control rate, survival rate and future toxic and adverse effects at year 1, 2 and 3 in patients with postoperative cervical cancer. Methods: Fifty-six postoperative cervical cancer patients, aged between 26 - 65 years old (median age of 42 years old) with postoperative radiotherapy indications have carried out the retrospective analysis from July 2007 to July 2011 in Guizhou Cancer Hospital of which 22 patients ≥ 50 years old and 34 patients < 50 years old. Twenty-five patients were in FIGO stage I and 31 patients of stage II. Postoperative pathology showed that 47 patients had squamous cell carcinoma and 9 patients of adenocarcinoma. Factors for postoperative supplement radiotherapy due to highly recurrent risks include positive pelvic lymph nodes (21 cases), lateral uterine invasion (4 cases), invasive depth of neoplasm in excess of 1/2 (20 cases), vessel invasion (11 cases), 56 patients in radiotherapy with full pelvic IMRT, and external exposure of DT50.4 Gy/28 f/5 W. Patient was received Ir¹⁹² close range radiotherapy after one month of postoperation, 5 Gy/week, DT20 Gy, as well as paclitaxel (135 - 175 mg/m²) + cisplatin (60 - 80 mg/m²) simultaneous and/or synchronous chemotherapy 2 - 4 cycles. Follow-up was lasting for 3 - 36 months and the total follow-up rate was 95%. Results: One-year overall survival rate and partial pelvic control rate were 100.0% and 96.4%; two-year overall survival rate and partial pelvic control rate were 98.2% and 96.4%; three-year overall survival rate and partial pelvic control rate were 94.6% and 89.2%. Positive lymph nodes and lateral uterine invasion were independent prognostic factors that impacted the overall survival rate while staging, vessel invasion were independent prognostic factors of partial pelvic control rate. According to (RTOG) evaluation criteria of acute and chronic radiation reactions, grade I further rectal reaction was 26.8% and 8.9% for grade II and 1.7% for grade III; grade I further urinary reaction was 23.2% and 5.3% for grade II and 0% for grade III; and grade I further hematological toxicity was 41.1% and 30.3% for grade II and 8.9% for grade III. Conclusion: A satisfactory effect can be achieved on partial pelvic control rate and overall survival rate in IMRT treatment for patients with postoperative cervical cancer, which is in accordance with results reported in several published documents. Moreover, the radiotherapy-related further toxic and adverse effects can be acceptable.