介入化疗加放疗治疗中晚期宫颈癌的临床研究

宫颈癌是最常见的妇科恶性肿瘤,外科手术仅适于早期患者,中晚期宫颈癌传统治疗方法以放射治疗为主,其有效率较为有限。为进一步提高疗效,1998年3月～1999年5月我们对40例晚期宫颈癌应用介入化疗加放疗,并与同期单纯放疗的40例进行对比,现报告如下。     

非根治剂量的体外照射配合腔内放疗加根治术治疗宫颈癌

目的 总结分析外照射配合腔内放疗加根治术治疗Ⅰb-Ⅲa期宫期癌的5年生存率和晚期并发症。方法 106例宫颈癌均行广泛性子宫切除和盆腔淋巴结清除术,其中78例行术前放疗（体外加腔内放疗,下同）,16例采用腔内放疗＋手术,12例术后放疗。外照射采用^60Co治疗机,给予合盆或盆腔四野照射,B点剂量术前放疗者为25－30Gy,术后放疗者为40－50Gy;腔内放疗采用^192Ir高剂量率后装机,A点剂量6－18Gy。结果 （1）5年生存率：Ⅰb-Ⅲa期术前放疗组为78.2%（61／78）,腔内＋手术组为68.8%（11／16）,术后放疗组为33.3%（4／12）。术前放疗组与术后放疗组相比,差异有显著性（P＜0.05）。术前放疗组中,Ⅱ期患者的5年生存率(77.6%,45／58）高于术后放疗组（1／4,P＜0.05）。（2）主要并发症：多为放射性直肠炎和膀胱炎。术前放疗组、腔内放疗＋手术组和术后放疗组的并发症发生率分别为34.6%(27/78）、31.3%（5／16）和33.3%(4/12),差异无显著性（P＞0.05）。结论 非根治量的体外照射配合腔内放疗加根治术治疗宫颈癌,可提高Ⅰb-Ⅲa期患者总的5年生存率和Ⅱ期患者的5年生存率,晚期并发症发生率差异无显著性。     

宫颈癌根治术后三维适形放疗的临床价值

Objective:To observe the clinical value of three dimensional conformal radiation therapy (3D-CRT) followed by radical surgery and discuss the best radiation technique for cervical cancer patients after radical hysterectomy.Methods:From February 2003 to June 2006,115 stage Ⅰ-Ⅲa uterus cervix cancer patients received postoperation radiotherapy in our department after radical surgery.They were randomly divided into two groups.There were 81 patients in 3D-CRT group and 74 patients in traditional radiation group.According to FIGO,there were 45 in stage Ⅰ,77 in stage Ⅰa,31 in stage Ⅱb,2 in stage Ⅲa.Pathological examination confirmed that 148 cases had squamous carcinoma and 7 cases had adenocarcinoma.The target volume included supravaginal portion,the cervical stump,paracervical tissue,common iliac lymph nodes,internal and external iliac lymph nodes,obturator and sacral lymph nodes.For 3D-CRT group we designed four-field or two-fields rotating irradiation in the left-right and the anterior-posterior direction.For traditional radiation group we designed two-field,anterior-posterior,at opposed lateral directions.The radiation dose ranged from 48-50 Gy.Stage Ⅱb patients with a cervical stump recurrence received postoperative boost radiation by 8-10 Gy.Results:There were no significant difference in 0.5-year,1-year,1.5-year,2-year local control rate between 3D-CRT group and traditional radiation group (P＞0.05).The occurrence of early and late complications was significant lower in 3D-CRT group than that in traditional radiation group (P＜0.05).There was significant difference in gastrointestinal reaction and urinary system reaction between the two groups (P＜0.05).In postoperation radiotherapy 3D-CRT was superior compared with traditional two-field radiation at opposed lateral direction.Conclusion:3D-CRT is superior compared with traditional radiation.Four-field rotating irradiation in 3D-CRT has advantages of dose focusing,even dose distribution and cause less side effects and complications.The side-field and cervical stump-targeted boost irradiation are apparent advantages of 3D-CRT.     

手术与手术联合放化疗对70例喉癌患者的临床效果比较

目的分析研究经手术与手术联合放化疗治疗70例喉癌患者中的临床效果比较及远期并发症。方法选取喉癌患者70例,随机分成对照组和观察组2组,各35例,对照组仅行手术切除,试验组行手术+放化疗治疗,分析比较2组的临床效果及远期并发症情况。结果观察组35例喉癌患者中Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者术后5年生存率分别为90.91%、61.54%、44.44%、0,与对照组(83.33%、58.33%、44.44%、0)相比无显著性差异,临床总有效率远远高于对照组,差异具有统计学意义(P<0.05),且观察组5年总生存率(60.00%)与对照组(62.86%)较接近,P>0.05。观察组复发转移总发生率为34.28%,与对照组(37.14%)相比无统计学差异,P>0.05。观察组术后2例喉腔狭窄、3例肺部感染、3切口感染、2例皮下气肿、1例第二原发恶性肿瘤(食管癌),对照组术后2例喉腔狭窄、4例肺部感染、2切口感染、3例皮下气肿、2例第二原发恶性肿瘤(食管癌),两组对比无统计学差异,P>0.05。观察组术后的总满意度(74.28%)与对照组(77.14%)接近,不存在统计学差异(P>0.05)。结论针对于喉癌患者,采用手术疗法与手术联合放化疗治疗的术后生存率、复发转移情况无明显差异,两种方式的并发症并无显著不同,但针对不同患者可采取相应放化疗进行延缓病情发展,本研究对临床上研究喉癌治疗具有参考价值。     

后程三维适形放疗结合化疗治疗67例中晚期宫颈癌的临床观察

目的：探讨不作腔内后装治疗的中晚期宫颈癌采用后程三维适形放疗结合化疗的疗效。方法：67例宫颈癌随机分为三维适形放疗加化疗组31例（适形组）与常规放疗加化疗组36例（常规组）,适形组患者均不作腔内后装治疗,先采用6MvX 线全盆腔放疗DT40Gy后采用三维适形放疗针对盆腔淋巴区及宫颈原发灶继续照射19Gy,最后再缩野针对宫颈原发灶推量,使宫颈原发灶总量达70～75Gy。常规组则采用全盆腔放疗40Gy后改为盆腔四野照射20Gy,腔内后装治疗A 点剂量30Gy/5 次,使宫颈原发灶A 点达70Gy。两组均作同期化疗,方案为：顺铂30mgd 1～3,5-FU 500mg/m2,d1～5,静脉滴注,第1 周、第5 周各一次。结果：适形组和常规组1、2 年生存率分别为93.5％、90.3％和83.3％、72.2％（P=0.198 和P=0.062）,无显著统计学意义。3 年生存率分别为87.1％和61.1％（P=0.017）,两组有显著的统计学意义。两组毒副作用比较,适形组Ⅰ～Ⅱ级放射性直肠炎及盆腔纤维化发生率低于常规组（P=0.000 和P=0.015）,其他的毒性相似。结论：后程三维适形放疗合并化疗治疗中晚期宫颈癌是一种有效、肯定的治疗方法,能提高患者近期生存率,晚期并发症较常规放疗低。3DCRT在宫颈癌放疗中的作用仍需大宗病例和长期随访来验证其优越性。     

Good Outcomes of Patients with Stage IB Endometrial Cancer with Surgery Alone

Background: Most patients with endometrial cancer have stage I disease. Adjuvant therapy in stage IB(formerly IC) endometrial cancer is controversial, treatment options including observation or brachytherapy/radiotherapy in grade 1-3 patients with or without chemotherapy. The purpose of this study was to assessthe outcomes of our patients with stage IB endometrioid endometrial cancer. Materials and Methods: Sixtytwo patients with stage IB endometrial cancer and endometrioid histology were retrospectively evaluated. Allpatients were initially treated surgically by the same surgeon with comprehensive staging, i.e. total abdominalhysterectomy, bilateral salphingooopherectomy, bilateral pelvic and paraaortic lymph node dissection andomentectomy. Adjuvant radiotherapy was discussed with patients and utilized by those who accepted. Adjuvantchemotherapy was not given to any of the patients. Results: Median age was 62 (range, 42-95). Ninety percentof the patients had grade 1-2 disease. Thirteen patients (21%) received intra vaginal brachytherapy (IVBT) andone received whole pelvic radiotherapy (WPRT). Median follow-up time was 46 months (range, 9-77 months).Three patients experienced recurrence (4.8%), two of them died on follow-up and one was still alive at last visit.Two patients with recurrence had FIGO grade 2 tumors and one had a grade 3 tumor. Two patients (3.2%)died without evidence of recurrent disease. Relapse free survival at 5 years was 94.4% and overall survival was93.1%. Conclusions: Patients with stage IB disease in our study demonstrated relatively low recurrence rates although the majority of them received no adjuvant treatment. Surgery alone may be sufficient for most patients with this stage of endometrial cancer.     

根治手术与放疗辅助常规化疗对早期声门型喉癌局部控制率、生存率及并发症的影响

目的 研究根治手术与放疗分别辅助常规化疗对早期声门型喉癌患者局部控制率、生存率及并发症风险的影响.方法 选择早期声门型喉癌患者80例.采用随机数表法分为放疗组和手术组,每组各40例,放疗组给予放疗辅助小剂量化疗,手术组给予根治手术辅助小剂量化疗.比较两组患者的临床疗效、喉功能改善情况、并发症和复发转移情况.结果 放疗组患者的生存率、无瘤生存率和局部控制率分别为95.00％、80.00％和85.00％,手术组分别为92.50％、87.50％和90.00％,差异无统计学意义(P＞0.05).放疗组喉功能完全改善和部分改善例数多于手术组,未改善例数少于手术组,差异有统计学意义(P＜0.05).手术组出现1例喉腔狭窄,2例皮下气肿,2例肺部感染和6例切口感染,放疗组出现3例吞咽困难,3例肺部感染和7例放射性皮炎/咽炎,两组患者并发症比较差异无统计学意义(P＞0.05).手术组有8例出现复发,其中原发灶复发6例,颈部淋巴结转移2例,放疗组患者有9例出现复发,其中其中原发灶复发7例,颈部淋巴结转移2例,两组患者的复发转移情况比较差异无统计学意义(P＞0.05).结论 根治手术与放疗分别辅助常规化疗对早期声门型喉癌患者的疗效相近,效果较好,并发症和复发转移情况类似,放疗辅助常规化疗对喉功能的影响较小,患者生活质量较高.     

根治性放疗与根治性手术治疗肌层浸润性膀胱癌的Meta分析

[目的]系统评价根治性放疗与根治性手术治疗膀胱癌临床效果.[方法]应用END-NOTE软件全面检索Pubmed(1973～2013年)数据库,对符合纳入标准的临床对照试验,采用RevMan 4.3软件进行Meta分析.对于无对照临床研究资料,采用同质合并分析.[结果]共纳入6个临床对照试验,共1 264例患者,Meta分析结果显示,根治性放疗与根治性手术切除治疗膀胱癌患者的5年生存率无统计学差异(P=0.36),合并比值比(OR)为1.10 (95％CI:0.86～1.40).18篇无对照临床研究共纳入根治性放疗治疗膀胱癌患者1 749例,多数文献采用全膀胱放疗40～60Gy,联合以顺铂为基础的化疗方案,完全反应率达到65％以上,平均5年总生存率在50％以上,最低为37％,最高可达82％.[结论]根治性放疗不会降低膀胱癌患者生存率,且能维持正常膀胱功能,提高了患者生存质量.     

Acute and Late Toxicity in Radical Radiotherapy for Bladder Cancer

AimsTo evaluate the incidence, severity and kinetics of acute and late toxicity from bladder and bowels in patients with bladder cancer treated with radical radiotherapy.Materials and methodsThe retrospective analysis was based on 487 patients with T2, T3 bladder cancer, treated with radiotherapy between 1975 and 1995. The pelvis was irradiated electively in 303 patients; in the remaining patients, the bladder alone was treated. The mean total radiation dose to the bladder was 65.5 Gy. Various schedules of protracted, conventional and accelerated radiotherapy were used. The influence of selected factors on maximum acute toxicity and late toxicity was assessed. The kinetics of acute toxicity was also evaluated. The median follow-up was 76 months.ResultsSeven patients did not complete treatment due to excessive acute toxicity. The incidence of grade ≥3 acute bladder and bowel toxicity was 5 and 3%, respectively. The actuarial, 5-year incidence of grade ≥3 late bladder and bowel toxicity was 12 and 3%, respectively. The most important factors influencing acute toxicity were: T-stage (P = 0.004) for the bladder and pelvic irradiation (P = 0.044) and dose intensity (P = 0.000) for the bowels. The latency of both early bladder and bowel toxicity was correlated with dose intensity. The most important factor influencing late bladder toxicity was acute toxicity score (P = 0.000). Late bowel toxicity was also influenced by acute bowel toxicity (P = 0.04).ConclusionsThe severity of acute bowel toxicity is related to pelvic irradiation and dose intensity. The severity of acute bladder toxicity depends on T-stage. The increase in dose intensity is associated with shorter latency to maximum acute bladder and bowel toxicity. The severity of acute bladder and bowel toxicity influences the risk of late effects from those organs.     

宫颈癌根治术后并发无症状盆腔淋巴囊肿调强放疗的临床研究

目的： 探讨宫颈癌根治术后并发无症状淋巴囊肿（pelvic lymphocyst,PL）患者进行调强放疗（intensity modulated radiotherapy,IMRT）的可行性。方法：2015年1月至2016年2月期间我科收治的宫颈癌根治术后具有放疗指征的患者共92例,根据模拟定位计算机断层扫描（computed tomography,CT）时是否发现PL分为实验组（有PL且PL直径≤6cm,46例）和对照组（无PL,46例）。实验组临床靶区（clinical target volume,CTV）勾画将全部PL包括在内,两组均采用同样的IMRT技术制定治疗计划,通过剂量体积直方图（dose volume histogram,DVH）及放疗期间周围危及器官（organ at risk,OAR）小肠、直肠、膀胱的急性反应分析PL对IMRT的影响,并观察实验组PL在放疗结束时及放疗结束后3月的转归情况。〖HTH〗结果：〖HTSS〗实验组CTV体积明显大于无PL组,差异具有统计学意义（P<0.05）。在IMRT放疗方式中,两组小肠、直肠、膀胱受照剂量体积差异无统计学意义（P>0.05）。两组小肠、直肠、膀胱的急性放射性反应差异无统计学意义（P>0.05）。实验组PL放疗结束时有效率达60.61%,放疗后3个月达89.32%。结论：宫颈癌根治术后并发无症状PL患者及时给予术后IMRT不增加放疗期间小肠、直肠、膀胱的急性放射性反应,同时可以治愈PL。     

175例喉癌手术,放疗及手术加放疗的分析比较

本文分析经病理证明的喉癌１７５例。声门上区７７（４４％），声门区９１（５２％），声门下区７（４％）。按１９７８年ＵＩＣＣ喉癌临床分期标准：Ⅰ期２３例（１３．１％），Ⅱ期３６例（２０．６％），Ⅲ期６０例（３４．３％），Ⅳ期５６例（３２％），其治疗归纳为３组：单纯手术组２４例，手术加放疗组２６例，单纯放疗组１２５例。生存率按Ｋａｐｌａｎ－Ｍｅｉｅｒ氏生存曲线法分析比较：结果是Ⅰ、Ⅱ、Ⅲ期差别无显著性，