中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2013年
9期
649-653
,共5页
柯桂好%黄啸%黄晓炜%刘素萍%吴小华
柯桂好%黃嘯%黃曉煒%劉素萍%吳小華
가계호%황소%황효위%류소평%오소화
宫颈肿瘤%淋巴转移%化学疗法,辅助%放射疗法,调强适形
宮頸腫瘤%淋巴轉移%化學療法,輔助%放射療法,調彊適形
궁경종류%림파전이%화학요법,보조%방사요법,조강괄형
Uterine cervical neoplasms%Lymphatic metastasis%Chemotherapy,adjuvant%Radiotherapy,intensity-modulated
目的 探讨体外延伸野调强加腔内放疗联合化疗治疗子宫颈癌腹主动脉旁淋巴结转移的疗效及副反应.方法 回顾性分析2009年1月-2011年12月于复旦大学附属肿瘤医院治疗的46例Ⅰ b1期～Ⅳa期(包括Ⅰ b1期1例、Ⅱb期8例、Ⅲa期2例、Ⅲb期33例、Ⅳa期2例)子宫颈癌腹主动脉旁淋巴结转移患者的临床资料.46例子宫颈癌患者均予体外延伸野调强加腔内放疗联合化疗,具体方法为:采用体外延伸野调强放疗,延伸野剂量为50.4 Gy,1.8 Gy/次,共28次,对转移淋巴结、宫旁加量者加量6.0 ～8.0 Gy,外照射5周后补充腔内放疗,A点剂量为20.0～30.0 Gy,5.0 Gy/次,共4～6次；在放疗前、放疗中、放疗后分别给予1、2、3个疗程紫杉醇+卡铂方案的化疗.随访时间为15 ～ 50个月(中位随访时间为27个月),观察患者的治疗完成情况、生存情况和近、远期并发症的发生情况.结果 (1)治疗完成情况:完成放疗总时间为47 ～71 d,中位完成放疗时间为53 d;26例患者腹主动脉旁淋巴结加量放疗,37例患者接受盆腔肿大淋巴结或宫旁加量放疗.化疗的总疗程数为189个,每例患者平均4.1个(2～6个).(2)生存情况:患者的3年总生存率为61.2％,3年无瘤生存率为46.2％.21例(46％,21/46)患者复发,中位复发时间为16个月(9～ 35个月).(3)近、远期并发症:急性放、化疗反应:38例(83％,38/46)患者出现Ⅰ～Ⅲ级胃肠道反应,其中Ⅲ级胃肠道反应2例(4％,2/46)；46例(100％,46/46)患者均出现不同程度的骨髓抑制,其中Ⅲ～Ⅳ度骨髓抑制18例(39％,18/46)；27例(59％,27/46)患者出现Ⅰ级泌尿道反应.晚期放疗反应:21例(46％,21/46)患者出现Ⅰ～Ⅳ级放射性肠炎,其中Ⅲ～Ⅳ级放射性肠炎3例(7％,3/46)；4例(9％,4/46)患者出现Ⅱ级放射性膀胱炎.结论 体外延伸野调强加腔内放疗联合化疗治疗子宫颈癌腹主动脉旁淋巴结转移患者能获得满意的3年总生存率,且患者的耐受性较好.
目的 探討體外延伸野調彊加腔內放療聯閤化療治療子宮頸癌腹主動脈徬淋巴結轉移的療效及副反應.方法 迴顧性分析2009年1月-2011年12月于複旦大學附屬腫瘤醫院治療的46例Ⅰ b1期～Ⅳa期(包括Ⅰ b1期1例、Ⅱb期8例、Ⅲa期2例、Ⅲb期33例、Ⅳa期2例)子宮頸癌腹主動脈徬淋巴結轉移患者的臨床資料.46例子宮頸癌患者均予體外延伸野調彊加腔內放療聯閤化療,具體方法為:採用體外延伸野調彊放療,延伸野劑量為50.4 Gy,1.8 Gy/次,共28次,對轉移淋巴結、宮徬加量者加量6.0 ～8.0 Gy,外照射5週後補充腔內放療,A點劑量為20.0～30.0 Gy,5.0 Gy/次,共4～6次；在放療前、放療中、放療後分彆給予1、2、3箇療程紫杉醇+卡鉑方案的化療.隨訪時間為15 ～ 50箇月(中位隨訪時間為27箇月),觀察患者的治療完成情況、生存情況和近、遠期併髮癥的髮生情況.結果 (1)治療完成情況:完成放療總時間為47 ～71 d,中位完成放療時間為53 d;26例患者腹主動脈徬淋巴結加量放療,37例患者接受盆腔腫大淋巴結或宮徬加量放療.化療的總療程數為189箇,每例患者平均4.1箇(2～6箇).(2)生存情況:患者的3年總生存率為61.2％,3年無瘤生存率為46.2％.21例(46％,21/46)患者複髮,中位複髮時間為16箇月(9～ 35箇月).(3)近、遠期併髮癥:急性放、化療反應:38例(83％,38/46)患者齣現Ⅰ～Ⅲ級胃腸道反應,其中Ⅲ級胃腸道反應2例(4％,2/46)；46例(100％,46/46)患者均齣現不同程度的骨髓抑製,其中Ⅲ～Ⅳ度骨髓抑製18例(39％,18/46)；27例(59％,27/46)患者齣現Ⅰ級泌尿道反應.晚期放療反應:21例(46％,21/46)患者齣現Ⅰ～Ⅳ級放射性腸炎,其中Ⅲ～Ⅳ級放射性腸炎3例(7％,3/46)；4例(9％,4/46)患者齣現Ⅱ級放射性膀胱炎.結論 體外延伸野調彊加腔內放療聯閤化療治療子宮頸癌腹主動脈徬淋巴結轉移患者能穫得滿意的3年總生存率,且患者的耐受性較好.
목적 탐토체외연신야조강가강내방료연합화료치료자궁경암복주동맥방림파결전이적료효급부반응.방법 회고성분석2009년1월-2011년12월우복단대학부속종류의원치료적46례Ⅰ b1기～Ⅳa기(포괄Ⅰ b1기1례、Ⅱb기8례、Ⅲa기2례、Ⅲb기33례、Ⅳa기2례)자궁경암복주동맥방림파결전이환자적림상자료.46례자궁경암환자균여체외연신야조강가강내방료연합화료,구체방법위:채용체외연신야조강방료,연신야제량위50.4 Gy,1.8 Gy/차,공28차,대전이림파결、궁방가량자가량6.0 ～8.0 Gy,외조사5주후보충강내방료,A점제량위20.0～30.0 Gy,5.0 Gy/차,공4～6차；재방료전、방료중、방료후분별급여1、2、3개료정자삼순+잡박방안적화료.수방시간위15 ～ 50개월(중위수방시간위27개월),관찰환자적치료완성정황、생존정황화근、원기병발증적발생정황.결과 (1)치료완성정황:완성방료총시간위47 ～71 d,중위완성방료시간위53 d;26례환자복주동맥방림파결가량방료,37례환자접수분강종대림파결혹궁방가량방료.화료적총료정수위189개,매례환자평균4.1개(2～6개).(2)생존정황:환자적3년총생존솔위61.2％,3년무류생존솔위46.2％.21례(46％,21/46)환자복발,중위복발시간위16개월(9～ 35개월).(3)근、원기병발증:급성방、화료반응:38례(83％,38/46)환자출현Ⅰ～Ⅲ급위장도반응,기중Ⅲ급위장도반응2례(4％,2/46)；46례(100％,46/46)환자균출현불동정도적골수억제,기중Ⅲ～Ⅳ도골수억제18례(39％,18/46)；27례(59％,27/46)환자출현Ⅰ급비뇨도반응.만기방료반응:21례(46％,21/46)환자출현Ⅰ～Ⅳ급방사성장염,기중Ⅲ～Ⅳ급방사성장염3례(7％,3/46)；4례(9％,4/46)환자출현Ⅱ급방사성방광염.결론 체외연신야조강가강내방료연합화료치료자궁경암복주동맥방림파결전이환자능획득만의적3년총생존솔,차환자적내수성교호.
Objective To investigate the treatment effects and toxicities of extended-field intensity modulated radiation therapy (EF-IMRT) and intra-cavitary brachytherapy combined with chemotherapy for stage Ⅰ b1-Ⅳa cervical cancer with positive para-aortic lymph nodes.Methods A total of 46 stage Ⅰ b1-Ⅳa cervical cancer patients with positive para-aortic lymph nodes treated at Fudan University Shanghai Cancer Center between 2009 and 2011 were reviewed.Neoadjuvant,concomitant and adjuvant chemotherapy with paclitaxel and carboplatin were administrated for one cycle before radiation therapy,two cycles during radiation therapy or three cycles after radiation therapy.All patients received EF-IMRT and intra-cavitary brachytherapy.The positive lymph nodes received an additional boost dose.Results All patients received EF-IMRT to 50.4 Gy (1.8 Gy per fraction).Twenty-six patients was treated with boost dose of 6.0-8.0 Gy in 2.0 Gy per fraction to positive para-aortic lymph nodes.Thirty-seven patients received a positive paraaortic lymph nodes boost or(and) parametrial boost.All patient also received a high-dose-rate intra-cavitary brachytherapy at the point "A" dose of 20.0-30.0 Gy in 5.0 Gy per fraction.Total chemotherapy cycles were 189,and the average patient received 4.1 courses.Two cases (4％,2/46) experienced grade Ⅲ gastrointestinal toxicities,no patients suffered grade Ⅳ gastrointestinal toxicities.Fifteen cases (33％,15/46) experienced grade Ⅲ hematological toxicities,and 3 (7％,3/46) experienced grade Ⅳ hematological toxicities.Late grade Ⅲ-Ⅳ toxicity was seen in 3 cases (7％,3/46).The 3 year progressionfree survival rate was 46.2％,and the 3 years overall survival rate was 61.2％.Conclusion EF-IMRT and intra-cavitary brachytherapy combined with chemotherapy is safe and effective for stage Ⅰ b1-Ⅳa cervical cancer with positive para-aortic lymph nodes.
