56例宫颈癌术后调强放射治疗(IMRT)的疗效观察

Abstract

目的：回顾性分析宫颈癌术后IMRT治疗患者1、2、3年盆腔局部控制率、生存率及远期毒副反应。方法：回顾性分析2007年7月~2011年7月间贵州省肿瘤医院子宫颈癌根治术后具有术后放疗指征的患者56例，年龄在26~65岁之间(中位年龄42岁)，其中≥50岁患者22例， Objective: To retrospectively analyze IMRT treatment on partial pelvic control rate, survival rate and future toxic and adverse effects at year 1, 2 and 3 in patients with postoperative cervical cancer. Methods: Fifty-six postoperative cervical cancer patients, aged between 26 - 65 years old (median age of 42 years old) with postoperative radiotherapy indications have carried out the retrospective analysis from July 2007 to July 2011 in Guizhou Cancer Hospital of which 22 patients ≥ 50 years old and 34 patients < 50 years old. Twenty-five patients were in FIGO stage I and 31 patients of stage II. Postoperative pathology showed that 47 patients had squamous cell carcinoma and 9 patients of adenocarcinoma. Factors for postoperative supplement radiotherapy due to highly recurrent risks include positive pelvic lymph nodes (21 cases), lateral uterine invasion (4 cases), invasive depth of neoplasm in excess of 1/2 (20 cases), vessel invasion (11 cases), 56 patients in radiotherapy with full pelvic IMRT, and external exposure of DT50.4 Gy/28 f/5 W. Patient was received Ir192 close range radiotherapy after one month of postoperation, 5 Gy/week, DT20 Gy, as well as paclitaxel (135 - 175 mg/m2) + cisplatin (60 - 80 mg/m2) simultaneous and/or synchronous chemotherapy 2 - 4 cycles. Follow-up was lasting for 3 - 36 months and the total follow-up rate was 95%. Results: One-year overall survival rate and partial pelvic control rate were 100.0% and 96.4%; two-year overall survival rate and partial pelvic control rate were 98.2% and 96.4%; three-year overall survival rate and partial pelvic control rate were 94.6% and 89.2%. Positive lymph nodes and lateral uterine invasion were independent prognostic factors that impacted the overall survival rate while staging, vessel invasion were independent prognostic factors of partial pelvic control rate. According to (RTOG) evaluation criteria of acute and chronic radiation reactions, grade I further rectal reaction was 26.8% and 8.9% for grade II and 1.7% for grade III; grade I further urinary reaction was 23.2% and 5.3% for grade II and 0% for grade III; and grade I further hematological toxicity was 41.1% and 30.3% for grade II and 8.9% for grade III. Conclusion: A satisfactory effect can be achieved on partial pelvic control rate and overall survival rate in IMRT treatment for patients with postoperative cervical cancer, which is in accordance with results reported in several published documents. Moreover, the radiotherapy-related further toxic and adverse effects can be acceptable.