2016 年第 6 期 第 14 卷

局部晚期宫颈癌螺旋断层放疗同步化疗早晚期副反应分析

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关键词：宫颈恶性肿瘤螺旋断层放疗毒副反应同步化疗

• 摘要：
• 【摘要】目的 分析局部晚期宫颈癌螺旋断层调强（HT）放疗同步顺铂化疗和高剂量率后装照射（HDR）腔内照射的早晚期毒副反应及2年的疗效。 方法 2012年1月至2014 年1月本院收治的IB-IIIB期宫颈癌46例，均接受根治性放疗。外照射采用HT-IMRT，14例盆腔淋巴结受累进行勾画定义为GTVnd，临床靶区（CTV）包括盆腔淋巴结区（6例扩大野包括腹主动脉旁淋巴结区），GTVnd、全部子宫、宫颈及阴道，外扩0.8-1厘米构成计划靶区（PTV）。PTV中位剂量50.4Gy(范围，45-50.4Gy)，常规分割。同步顺铂化疗，40mg/m2/周。外照射30-40Gy后联合腔内照射，HDR的A点中位剂量30Gy（范围，30-36Gy），总的A点生物等效剂量（EQD2）90.3Gy (范围，84.9-98.3Gy)。结果 24例患者完成4-5周期同步化疗，22例患者仅完成2-3周期。3度急性反应包括：白细胞减少9例(19.6%)，腹泻2例(4.3%)，恶心5例(10.9%)及呕吐1例(2.2%)；晚期3度反应2例：1例直肠出血，1例膀胱出血；无任何4及5度早晚毒副反应发生。2年无复发生存率，无病生存率及总生存率分别为 91.7%, 86.0% ，97.1%。结论 局部晚期宫颈癌螺旋断层调强放疗同步每周顺铂化疗联合HDR腔内照射，急性毒副反应以血液学及恶心为主，晚期副反应低，近期疗效较好。
• Objective To investigate the acute and late toxicities and 2-year treatment outcomes in cervical cancer patients undergoing helical tomotherapy(HT) with concurrent chemotherapy and brachytherapy. Method We analyzed data from January 2012 to January 2014, 46 patients with stage IB-IIIB cervical cancer. The external beam irradiation utilized HT technique. Forty patients received pelvic irradiation and 6 patients received extended- field irradiation. All patients received concurrent chemotherapy with single-agent weekly cisplatin at 40mg/m2 during HT treatment. The median prescribed dose for planning target volume (PTV) was 50.4Gy (range， 45-50.4Gy) at 1.8-2.0Gy per fraction. After HT 30-40Gy, all patients received brachytherapy weekly 30-32Gy at 5-6 fractions to point A. The total EQD2 to point A was 90.3Gy (range, 84.9-98.3). Result Twenty-four patients completed 4-5 cycles of concurrent chemotherapy and 22 patients completed 2-3 cycles. Acute grade 3 leukopenia, diarrhea, nausea and vomiting occurred in 9(19.6%), 2(4.3%), 5(10.9%), and 1(2.2%) patients, respectively. Acute grade 3 anemia, thrombocytopenia, and genitourinary were not observed. Late grade 2 toxicities occurred in 3 patients (1 with severe rectal bleeding and 1 with severe bladder bleeding). Neither acute nor late grade 4 or 5 toxicity occurred. The 2-year recurrence- free survival, disease- free survival and overall survival were 91.7%, 86.0% and 97.1%, respectively. Conclusion HT with concurrent chemotherapy and brachytherapy was feasible with acceptable late toxicities and acute toxicities except in leukopenia and nausea. The local control rate and overall survival rate were good.