早期宫颈癌术后螺旋断层放疗与常规调强放疗近期疗效及预后因素分析

赵潇; 周桂霞; 解传滨; 葛瑞刚; 杨微

doi:10.3969/j.issn.2095-5227.2014.01.006

早期宫颈癌术后螺旋断层放疗与常规调强放疗近期疗效及预后因素分析

Short-term curative effect of HT and IMRT on early cervical cancer after operation and its prognostic factors

摘要

摘要: 目的探讨宫颈癌术后螺旋断层放疗(helical tomotherapy，HT)与调强放疗(intensity-modulated radiation therapy，IMRT)近期疗效及预后影响因素。方法 2008年7月30日- 2013年1月31日我院行宫颈癌术后放疗患者270例，HT 186例、IMRT 84例。盆腔淋巴引流区照射DT 46 ～ 50 Gy/23 ～ 28 F；高危淋巴引流区照射DT 54 ～ 60 Gy/25 ～ 28 F；残留肿瘤及转移淋巴结照射DT 64 ～ 66 Gy/25 ～ 28 F。阴道后装放疗2 ～ 4次，黏膜表面照射剂量8 Gy/次。观察患者直肠和膀胱放疗反应及1 ～ 3年生存率，分析有无化疗、淋巴结转移个数、临床分期及病理类型与预后关系。结果 HT组和IMRT组1级直肠反应发生率分别为29.03%和44.05%(P=0.016)；1级急性膀胱反应发生率分别为12.37%和16.67%(P=0.341)；直肠和膀胱均未出现≥2级急性反应发生。HT组和IMRT组1 ～ 3年总生存率分别为96.3%、90.5%、86.5%和93.1%、90.1%、71.9%(P=0.164)；两组Ⅰ期患者1 ～ 3年总生存率分别为97.5%、88.9%、86.8%和91.0%、87.5%、78.6%(P=0.372)；Ⅱ期患者1 ～ 3年总生存率分别为95.2%、92.5%、86.2%和94.9%、92.2%、64.6%(P=0.226)。单因素分析显示有无化疗及淋巴结转移个数与预后相关；多因素分析提示有无化疗及淋巴结转移个数是影响生存的独立预后因素。结论 HT在减少直肠急性放疗反应上比IMRT有明显优势。化疗及较少淋巴结转移可改善预后。

Abstract: Objective To study the short-term curative effect of HT and IMRT on early cervical cancer after operation and its prognostic factors. Methods Of the 270 cervical cancer patients admitted to our hospital from July 30, 2008 to January 31, 2013, 186 underwent HT and 84 underwent IMRT. Their pelvic lymph nodes drainage area, high risk lymph nodes drainage area, and residual tumor or metastatic lymph nodes area were irradiated at the dose of DT 46-50 Gy/23-28 F, DT 54-60 Gy/25-28 F and DT 64-66 Gy/25-28 F, respectively. Their vaginal wall received 2-4 times of intro vaginal brachytherapy and its mucosal surface was irradiated at the dose of 8 Gy/time. The response of their bladder and rectum to radiotherapy and the 1-, 2- and 3- year survival rates were recorded. Relation of chemotherapy, metastatic lymph nodes, clinical stage and pathological type with the prognosis of patients was analyzed. Results The incidence of grade 1 rectum response to HT and IMRT was signifcantly higher than that of grade 1 acute bladder response to HT and IMRT (29.03% and 44.05% vs 12.37% and 16.67%, P=0.016, P=0.341). No one≥2 grade acute rectum and bladder response to HT and IMRT occurred. The 1-, 2-, 3- year overall survival rate was 96.3%, 90.5%, 86.5% respectively in patients after HT and 93.1%, 90.1%, 71.9% respectively in patients after IMRT (P=0.164), and 97.5%, 88.9%, 86.8% respectively in stageⅠpatients after HT and 91.0%, 87.5%, 78.6% respectively in stageⅠpatients after IMRT (P=0.372), and 95.2%, 92.5%, 86.2% respectively in stage 2 patients after HT and 94.9%, 92.2%, 64.6% respectively in stage 2 patients after IMRT (P=0.226). Univariate analysis revealed that chemotherapy and metastatic lymph nodes were related with the prognosis of patients. Multivariate analysis displayed that chemotherapy and metastatic lymph nodes were the independent factors for the prognosis of patients. Conclusion The response of rectum to HT is better than that of IMRT with less metastatic lymph nodes involved and can improve the prognosis of patients.

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