术后调强放疗对早中期宫颈癌有效性与安全性分析

摘要/Abstract

摘要： 目的：探讨术后调强放疗对早中期宫颈癌的有效性与安全性。方法：选取我院2014年1月至2016年12月206例行手术治疗的Ⅰ~Ⅱa期宫颈癌患者作为研究对象，采用随机数字表法将患者分为观察组和对照组，每组各103例，分别于术后行调强放疗、常规放疗，根据具体情况决定是否进行同步化疗。比较两组患者疗效、并发症及生活质量评估量表（FACT-Cx）生活质量评分。结果：观察组全部患者计划靶区的平均照射剂量为（45.9±0.5）Gy，照射体积百分比（V45）为（94.9±1.2）%。两组患者治疗总有效率分别为97.1%、92.2%，术后复发率分别为1.9%、3.9%，两组比较差异均无统计学意义（P＞0.05）。两组患者无一例死亡。全部患者均未发生Ⅳ级急性放射性肠炎与急性放射性膀胱炎。观察组患者急性放射性肠炎与急性放射性膀胱炎发生情况优于对照组，差异均有统计学意义（P＜0.05）。放疗结束时两组患者的FACT-Cx总分较放疗前降低，且观察组FACT-Cx总分高于对照组，比放疗前的降低值低于对照组，差异均有统计学意义（P＜0.05）。放疗后1年，两组患者的FACT-Cx总分较放疗前升高，且观察组的总分及放疗前的升高值均高于对照组，差异均有统计学意义（P＜0.05）。结论：术后调强放疗与常规放疗对早中期宫颈癌均有较理想的近、远期疗效，与常规放疗相比，术后调强放疗能降低急性放射性肠炎与急性放射性膀胱炎的发生风险，提高生活质量。

Abstract: Objective：To investigate the efficacy and safety of postoperative intensity-modulated radiotherapy for early and middle stage cervical cancer. Methods： 206 patients with early and middle stage cervical cancer in our hospital from January 2014 to December 2016 were selected as subjects for the study， and the patients were divided into the observation group and the control group by random number table method， 103 cases in each group. Patients in the observation group and the control group were given postoperative intensity-modulated radiotherapy and routine radiotherapy respectively，and then they could be given concurrent chemotherapy according to state of illness. The efficacy， complications and FACT-Cx quality of life score were compared between the two groups. Results：The average dose of planning target volume in the observation group was(45.9±0.5)Gy， and V45 was (94.9±1.2)%.The total effective rate in the observation group and the control group were 97.1% and 92.2% respectively， and the recurrence rate were 1.9% and 3.9% respectively. There was no statistical significance of the difference between the two groups (P>0.05).None of the patients died. There was no case occurred grade Ⅳ acute radiation enteritis and cystitis. The occurrence of acute radiation enteritis and acute radiation cystitis in the observation group were better than that in the control group (P<0.05). The total score of FACT-Cx in the two groups decreased immediately after radiotherapy，and the total score of FACT-Cx in the observation group was higher than that in the control group， and the reduced value was lower than that in the control group (P<0.05).The total score of FACT-Cx increase at 1 year after radiotherapy， and the total score and elevated value in the observation group were higher than those in the control group， and the difference was statistical significance(P<0.05). Conclusion：Postoperative intensity-modulated radiotherapy and conventional radiotherapy all have ideal short-term and long-term effects on early and middle stage cervical cancer. Compared with conventional radiotherapy，postoperative intensity-modulated radiotherapy can significantly reduce the risk of acute radiation enteritis and acute radiation cystitis， improve the quality of life.

周虹,陈丽. 术后调强放疗对早中期宫颈癌有效性与安全性分析[J]. .

ZHOU Hong and CHEN Li. Efficacy and Safety of Postoperative Intensity-modulated Radiotherapy for Early and Middle Stage Cervical Cancer[J]. .

参考文献

[1]张宁,王凡,童铸廷,等.图像引导宫颈癌体外自适应放疗的剂量学研究[J].安徽医科大学学报,2015,(5):699-701.
[2]吴丽丽,谢文佳,张武哲,等.宫颈癌根治性放疗旋转容积调强技术及固定野动态调强放疗技术的剂量学差异[J].中国老年学杂志,2014,(10):2617-2620.
[3] Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC) [J]. Int J Radiat Oncol Biol Phys, 1995, 31(5):1341-1346.
[4]吴红娟,陈雪峰,潘祯,等.宫颈癌患者放疗后生活质量现状调查及影响因素分析[J].中华现代护理杂志,2015,(27):3245-3249.
[5] Ryu SY, Park SI, Nam BH, et al. Is adjuvant chemoradiotherapy overtreatment in cervical cancer patients with intermediate risk factors?[J]. Int J Radiat Oncol Biol Phys, 2011, 79(3):794-799.
[6] Bouchard M, Nadeau S, Gingras L, et al. Clinical outcome of adjuvant treatment of endometrial cancer using aperture-based intensity-modulated radiotherapy[J]. Int J Radiat Oncol Biol Phys, 2008,71(5):1343-1350.
[7]Guckenberger M, Richter A, Krieger T, et al. Is a single arc sufficient in volumetric-modulated arc therapy (VMAT) for complex-shaped target volumes?[J]. Radiother Oncol, 2009, 93(2):259-265.
[8]王晓婓,陈玉丙,韩志龙,等.调强放疗与三维适形放疗联合腔内放疗同步化疗治疗中晚期宫颈癌的对比[J].中国老年学杂志,2013,33(17):4119-4121.
[9]翟垚青,闫文静,乔志燕.子午流注针法联合干扰素治疗对宫颈癌合并HPV感染患者T淋巴细胞亚群的影响[J].世界中医药,2018,13(5):1242-1245.
[10]陈静,丁乾,罗鸣,等.宫颈癌调强放射治疗的临床研究[J].华中科技大学学报(医学版),2012,41(3):353-357.
[11]王小燕,朱慧芬,高贵花,等.保留盆腔神经对宫颈癌患者术后生存质量的影响[J].安徽医药,2016,20(6):1154-1155.
[12]刘丽珺,王效,罗思羽,等.FIGO Ⅰ-Ⅱ期宫颈癌患者住院期间生存质量及影响因素研究[J].中国妇幼健康研究,2016,27(5):577-580,586.
[13]翁川,刘金鹏.三维适形放疗(3D-CRT)与调强放疗(IMRT)对ⅡB期宫颈癌患者预后和生活质量的影响[J].临床医学研究与实践,2016,1(20):154,156.
[14] 陈枫,朱磊,朱锡旭,等.个性化口腔定位支架在头颈部肿瘤患者调强放疗中的应用[J].医学研究生学报,2017,30(5):491-494.
[15] 刘跃平,许晶,张连胜,等.前列腺癌大分割精确放疗分次治疗间和分次治疗内位置变动分析[J].中华放射肿瘤学杂志,2016,25(11):1199-1203.
[16] 郭跃信,王海洋,刘乐乐,等.早期非小细胞肺癌不同放疗技术的剂量学差异分析[J].中华放射肿瘤学杂志,2017,26(1):62-65.
[17] 蔡海莹,周锦魁,谢扬,等.中晚期宫颈癌术后辅助放疗与IMRT的临床研究[J].中国实用医刊,2017,44(7):116-119.
[18] 倪镌,殷卓敏,袁淑慧,等.妇科恶性肿瘤患者术后辅助不同方式放疗的对比研究[J].中华妇产科杂志,2017,52(3):168-174.
[19] 张霞,王赟,俞青苗,等.调强放疗对宫颈癌术后伴中危因素患者生存质量的影响[J].中华全科医学,2017,15(12):2045-2047,2144.
[20] 汪露,余春风,黄燕飞,等.基于离线自适应放疗的宫颈癌病例靶区外扩边界及其剂量评估[J].中华放射医学与防护杂志,2017,37(12):902-905,910.

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