摘要
目的回顾性分析宫颈癌患者术后放疗的疗效、晚期副反应及预后因素。方法搜集2005年2月前6年接受术后放疗的Ⅰa～Ⅱb期宫颈癌病例114例，其中年龄24～72岁（中位值42．5岁）；FIGO临床分期Ⅰa期6例、Ⅰb1期51例、Ⅰb2期18例、Ⅱa期26例、Ⅱb期13例；术后病理为鳞癌92例、腺癌19例、腺鳞癌2例、未分化癌1例。113例采用加速器6、15MVX线盒式4个野常规放疗40～60Gy（中位值50Gy），81例放疗后4周加192Ir近距离治疗，参考点在阴道黏膜下0．5cm，1～6次，4～30Gy（中位值16Gy）。87例接受术前或（和）同步增敏化疗。随访5～75个月（中位值20个月），总随访率为92％。结果2年总生存率、无瘤生存率、盆腔控制率分别为93．1％、88．1％、94．6％，5年总生存率、无瘤生存率、盆腔控制率分别为75．7％、62．3％、85．6％。淋巴结转移及阴道残端阳性为总生存率的独立预后因素，阴道残端阳性为盆腔控制率的独立预后因素，分期、子宫下段受累及阴道残端阳性为无瘤生存率的独立预后因素。16例患者远处转移，最常见转移部位为肺、腹股沟及骨、肝及脑。RTOG分级晚期直肠反应发生率1级11．4％、2级11．4％、3级3．5％，泌尿系反应发生率1级14．0％、2级6．1％、3级0．9％。治疗后出现下肢水肿者8例。结论术后放疗在盆腔控制率上能达到较满意疗效，且放疗相关晚期副反应是可接受的，远处转移是致死主要问题。
Objective To analyze the efficacy,late complications and prognostic factors of post-operative radiotherapy for cervical cancer. Methods From Nov. 1999 to Feb. 2005,114 patients with cervi- cal cancer received adjuvant pelvic radiotherapy after radical hysterectomy and pelvic lymphadenectomy. The median age was 42.5 （24 to 72） years old. According to the FIGO staging system,6,51,18,26 and 13 patients had stage Ⅰa, Ⅰb1, Ⅰb2, Ⅱ a and Ⅱ b disease. The pathological type was squamous cell carcinoma,adenocarcinoma,squamous-adenocarcinoma and undifferentiated carcinoma in 92,19,2 and 1 patients, respec- tively. The whole-pelvic external beam irradiation of 50 Gy （40 to 60 Gy） was given with 6 MV or 15 MV Xray beams using four-field box technique. Eighty-one patients received intravaginal brachytherapy of 16 Gy （ 4 - 30 Gy in 1 - 6 fractions） 4 weeks after the beginning of radiotherapy, with the referrence point being at 0.5 cm under the vaginal mucosa. Eighty-seven patients received preoperative and/or concurrent chemotherapy. The survival and independent prognostic factors were analyzed by Log-rank method and Cox model. Results The median follow-up time was 26.0 （5 - 75 ） months. The overall survival rate, disease-free survival rate and local control rate were 93.1%, 88.1% and 94.6% at 2-year, and 75.7%, 62.3% and 85.6% at 5-year, respectively. The independent prognostic factors were lymph node metastasis and positive surgical margin for overall survival, positive surgical margin for local control, and stage, uterine body invasion and positive surgical margin for disease-free survival. Sixteen patients （ 14% ） had distant metastasis, and the most common sites were the lung, inguinal region, bone,liver and brain. According to RTOG grading system, the incidence of late gastrointestinal side effects of grade 1,2 and 3 was 11.4%, 11.4% and 3.5%. The corresponding genitourinary side effects were 14.0% ,6.1% and 0.9% , respectively. The incidence of leg lymphedema was 7 % . Conclusions Post - ope
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2009年第4期299-302,共4页
Chinese Journal of Radiation Oncology
基金
吴阶平基金会资助课题[WKJ2005-3-006（34）]
