摘要
目的比较同时加量(SIB)与后程加量(LCB)在宫颈癌伴盆腔或腹主动脉旁淋巴结转移患者行调强放疗中的应用。方法前瞻性选取2012年5月至2015年5月收治的宫颈癌伴腹腔淋巴结转移或盆腔淋巴结转移112例,通过随机数表法将所有患者分为SIB组(n=56)和LCB组(n=56),SIB组给予同时加量,LCB组给予后程加量。对比两组的临床疗效和毒副作用。结果放疗完成后SIB组的完全缓解(CR)为71.43%,明显高于LCB组的53.57%,差异有统计学意义(χ~2=4.827,P=0.037);放疗3个月后SIB组的CR为85.72%,明显高于LCB组的71.41%(χ~2=4.983,P=0.025);SIB组的疾病进展(PD)为0%,明显明显低于LCB组的7.14%(χ~2=4.381,P=0.036);LCB组满3年随访者共35例,SIB组满3年随访者共37例,两组存活率分别为65.7%和75.7%,SIB组存活率高于LCB组,差异有统计学意义(χ~2=4.305,P=0.038);SIB组的小肠最高剂量(Dmax)、直肠Dmax、膀胱1cc体积的剂量(D1cc)均明显高于LCB组,差异有统计学意义;SIB组的小肠2cc体积的剂量(D2cc)略高于LCB组,差异无统计学意义;SIB组骨髓毒性Ⅱ度、Ⅲ度和Ⅳ度以上比率均高于LCB组,差异有统计学意义(P<0.05);SIB组Ⅲ度以上持续时间为(3.23±1.52)d,显著低于LCB组的(6.87±2.43)d(t=8.371,P<0.001);SIB组骨髓剂量受照20 Gy体积占总膀胱体积百分比(V20)为(46.16±4.27)%,明显低于LCB组的(56.81±7.43)%(t=5.282,P<0.001)。结论调强放疗治疗宫颈癌伴盆腔或腹主动脉旁淋巴结转移SIB组的疗效显著高于LCB组,而安全性也高于LCB组,值得在临床中推广应用。
Objective To compare the application of SIB and LCB in the treatment of patients with cervical carcinoma with pelvic or abdominal aortic lymph node metastasis. Methods A total of 112 cases of cervical cancer with lymph node metastasis or pelvic lymph node metastasis were selected from May 2012 to May 2015. All patients were divided into SIB group（ n = 56） and LCB group（ n = 56） by random number table method. The SIB group was given synchronous dosage and the LCB group was given later course dosage. The efficacy and adverse reactions of two groups were compared. Results After radiotherapy,the CR of the SIB group was 71. 43%,significantly higher than that in the LCB group（ 53. 57%）（ χ~2= 4. 827,P = 0. 037）. After 3 months,the CR of the SIB group was 85. 72%,which was significantly higher than that in the LCB group of 71. 41%（ χ~2= 4. 983,P = 0. 025）; SIB group of PD was 0%,significantly lower than the LCB group（ 7. 14%）（ χ~2= 4. 381,P= 0. 036）. There were 35 patients for 3 years of follow-up in LCB group of,37 patients in SIB group,there was 65. 7% and 75. 7% survived respectively,the difference was statistically significant（ χ2= 4. 305,P = 0. 038）. Dmax of the small intestine,rectum,bladder and Dlcc in SIB group were significantly higher than those in LCB group,the difference was statistically significant. D2 cc in the small intestine in SIB group was slightly higher than that in LCB group,there was no significant difference. Bone marrow toxicity II,III and IV degree in SIB group were higher than those in LCB group,the difference was statistically significant（ P 〈 0. 05）; In SIB group more than III degree,the duration was（ 3. 23 ±1. 52）,which was significantly lower than that of LCB group（ 6. 87 ± 2. 43） d（ t = 8. 371,P 〈 0. 001）. The bone marrow dose V20 of SIB group was（ 46. 16 ± 4. 27） %,which was significantly lower than that of LCB group（ 56. 81 ± 7. 43） %（ t = 5. 282,P 〈 0. 001）. Conclusion The efficacy of the SIB group was significant
出处
《临床和实验医学杂志》
2018年第4期397-400,共4页
Journal of Clinical and Experimental Medicine
关键词
宫颈癌
转移淋巴结
调强放疗
同步加量
后程加量
Cervical cancer
Lymph node metastasis
Radiotherapy
Synchronous dosage
Later course dosage
