广州医科大学学报

目的:探讨图像引导调强放疗+腔内近距离放疗联合顺铂方案及调强适形放疗+腔内近距离放疗联合顺铂方案治疗中晚期宫颈癌的优劣。方法:回顾性分析2010-2016年梅州市人民医院收治的中晚期宫颈癌,50例采取图像引导调强放疗+腔内近距离放疗联合顺铂方案(IGRT组)治疗,50例采取调强适形放疗+腔内近距离放疗联合顺铂方案(IMRT组)治疗,比较两组近期疗效、急性不良反应发生率。结果:IGRT组完全缓解率为94%,部分缓解率为6%,高于IMRT组(完全缓解率88%,部分缓解率12%);IGRT组Ⅱ级+Ⅲ级皮肤黏膜反应、急性消化道反应、急性泌尿系反应及骨髓抑制的发生率分别为:30%、16%、28%、24%;IMRT组Ⅱ级+Ⅲ级皮肤黏膜反应、急性消化道反应、急性泌尿系反应及骨髓抑制的发生率分别为:32%、36%、30%、46%。两组皮肤黏膜反应及急性泌尿系反应差异无统计学意义(P>0.05),IGRT组骨髓抑制及急性消化道反应小于IMRT组(P<0.05)。结论:图像引导调强放疗+腔内近距离放疗联合顺铂方案治疗中晚期宫颈癌近期疗效确切,优于调强适形放疗+腔内近距离放疗联合顺铂方案,且毒副反应小,有利于治疗的顺利完成。

Objective: To investigate the advantages and disadvantages of image guided intensity-modulated radiotherapy( IGRT) + intracavitary brachytherapy combined with Cisplatin and intensity-modulated radiation therapy( IMRT) + intracavitary brachytherapy combined with Cisplatin in the treatment of advanced cervical cancer. Methods: The clinical data of patients with advanced cervical cancer,who were hospitalized in the Meizhou Municipal People's Hospital between 2010 and 2016,were retrospectively analyzed. Fifty cases were treated with IGRT+intracavitary brachytherapy combined with Cisplatin( IGRT group),and 50 cases were treated with IMRT + intracavitary brachytherapy combined with Cisplatin( IMRT group). The recent effect and the incidence of acute adverse reactions were compared between the two groups. Results: The complete remission rate in the IGRT group was 94%,and the partial remission rate was 6%,which was higher than that in the IMRT group( 88% complete remission rate,12% partial remission rate). The incidences of grade II + grade III skin and mucous membrane reaction,acute gastrointestinal reaction,acute urinary system reaction and bone marrow suppression in the IGRT group were 30%,16%,28% and 24%,respectively. The incidences of grade II + grade III skin and mucous membrane reaction,acute gastrointestinal reaction,acute urinary system reaction and bone marrow suppression in the IMRT group were 32%,36%,30% and 46%,respectively. There was no significant difference in the skin and mucous membrane reaction and acute urinary system reaction between the two groups( P>0.05). The bone marrow suppression and acute gastrointestinal reaction in the IGTT group were less than those in the IMRT group( P < 0. 05). Conclusion: The short-term effect of IGRT + intracavitary brachytherapy combined with Cisplatin in the treatment of advanced cervical cancer is identified,which is better than that of IMRT + intracavitary brachytherapy combined with Cisplatin with less toxic and adverse reactions. It favors the successful completion of the treatment.