调强适形放疗加后装放疗联合化疗在中晚期宫颈癌治疗中的临床研究

目的:研究调强适形放疗加后装放疗联合化疗治疗中晚期宫颈癌的临床疗效,探讨其临床意义。方法:选取2012年6月至2014年6月保定市第一中心医院放疗科收治的中晚期宫颈癌(IIb期、IIIa期和IIIb)患者121例,其中59例采用调强适形放疗联合化疗(IMRT组),62例采用三维适形放疗联合化疗(3D-CRT组)。比较两组患者的治疗和随访情况。结果:IMRT组的骨髓抑制发生率(32.2%vs 51.6%)、胃肠道反应发生率(42.4%vs 62.9%)、直肠反应发生率(27.1%vs 45.2%)均少于3D-CRT组,差异有统计学意义(P0.05)。IMRT组的泌尿生殖道损伤、放射性直肠炎和放射性膀胱炎发生率分别为18.6%、23.7%和16.9%,3D-CRT组分别为24.2%、25.8%和20.9%;两组比较差异均无统计学意义(P0.05)。随访3年,IMRT组的局部控制率高于3D-CRT组,差异有统计学意义(86.3%vs 70.1%,P0.05)。结论:相比三维适形放疗,调强适形放疗联合化疗治疗中晚期宫颈癌能提高肿瘤局部控制率,更好地保护危及器官,减少放疗副作用,具有重要的临床应用价值。     

局部晚期宫颈癌调强放疗联合同步化疗的临床研究

目的:探讨调强放疗联合同步放化疗对中晚期宫颈癌的近期临床疗效。方法:我院对59例局部晚期宫颈癌采用体外照射和腔内近距离照射的放疗方案:外照射采用直线加速器6MV-X线,每周5次,2GY/次/日。~(192)Ir腔内放疗A点量DT 70 Gy,B点量DT 50 Gy～56 Gy,6周完成。后装当天不行外照射。放疗同步顺铂40mg/m~2/次,每周1次。分为A、B两组均在放疗结束后评价疗效。结果:应用IMRT组靶区更精确,OAR的受照射剂量和体积均有明显减少。A组治疗有效率96.6%;B组80.0%。两组比较P<0.05,差异有统计学意义。结论:IMRT是治疗局部晚期宫颈癌一种有效手段,可减少放射性损伤及急慢性副反应的发生,提高患者生存质量。     

CT引导下三维腔内后装放疗在中晚期宫颈癌治疗中的临床应用

目的:探讨CT引导下三维腔内后装放疗在中晚期宫颈癌治疗中的临床疗效及安全性.方法:60例ⅡB～ⅢB期宫颈癌患者行CT引导下三维腔内后装放疗为实验组,同期选择60例ⅡB～ⅢB期宫颈癌患者行常规腔内后装放疗为对照组,二组均行盆腔外照射及常规顺铂每周同步化疗.治疗结束3个月后比较二组的近期疗效和毒副反应.结果:实验组完全缓解48例(80.0％),部分缓解12例(20.0％);对照组完全缓解31例(51.7％),部分缓解24例(40.0％),两组疗效比较差异有统计学意义(P =0.023).毒副反应主要为急性放射性肠炎及骨髓抑制,但两组间发生率比较差异均无统计学意义(P＞0.05).结论:CT引导下三维腔内后装放疗技术治疗中晚期宫颈癌近期疗效好,治疗更加精确且安全.     

三维适形、固定野动态调强和容积旋转调强在宫颈癌术后放疗中的剂量学比较

目的宫颈癌术后放疗中,比较三维适形(CRT)、固定野调强(IMRT)和容积旋转调强(VMAT)靶区剂量分布和危及器官受照剂量,为临床治疗技术的选择提供依据。方法顺序选取北京大学第三医院2013年10例宫颈癌术后放疗的患者,分别进行CRT、IMRT和VMAT计划设计并比较计划靶区的剂量-体积直方图(DVH)、适形度指数(CI)、均匀性指数(HI)和危及器官的受照剂量。结果三种技术CI分别为0.462、0.855和0.875,IMRT和VMAT均优于CRT,VMAT较IMRT有较小的优势(P0.05,t=-2.189);HI分别为1.084、1.063和1.046,VMAT均匀性略低于IMRT(P0.05,t=5.127)。在危及器官的受量上,CRT普遍高于IMRT和VMAT。对于低剂量区的受照体积,如小肠、结直肠、膀胱和骨髓的V10、V20,IMRT比VMAT可以获得更低的受照剂量(P0.05);对于高剂量区的体积V40、V50,直肠和膀胱的受照体积IMRT要小于VMAT(P0.05),其他如小肠、结肠和股骨头、骨髓的IMRT和VMAT差异无统计学意义(P0.05)。结论对于宫颈癌术后放疗的患者,CRT、IMRT和VMAT均可以达到靶区处方剂量覆盖的要求,但是在靶区的各项指标中,IMRT和VMAT均优于CRT。IMRT和VMAT相比,在HI上有优势,但是在CI指数上略小于VMAT;对于危及器官而言,低剂量体积和高剂量体积的IMRT和VMAT各自表现了不同的特点,在临床治疗中要根据要求选择不同的技术。     

三维适形放疗联合同步化疗治疗宫颈癌放疗后复发的临床观察

目的:评价三维适形放疗联合同步化疗,治疗宫颈癌放疗后盆腔复发的近期疗效和毒副反应.方法:2006年6月至2009年12月收治的宫颈癌放疗后盆腔复发病例23例为观察组,实施三维适形放疗及同步化疗,盆腔外照射肿瘤总量40～60Gy.并以同期采用盆腔前后野照射及同步化疗的宫颈癌放疗后盆腔复发病例共29例作为对照组,盆腔外照射...     

三维适形放疗联合同步化疗治疗晚期宫颈癌的疗效观察

目前治疗中晚期宫颈癌的主要方法是同步放化疗,提高晚期及复发、淋巴结转移、脏器转移患者的疗效是临床医生努力的方向.近年随着计算机技术的发展,三维适形放疗(three-dimensional conformal radiotherapy,3DCRT)及调强放疗(intensity modulated radiotherapy,IMRT)应用于肿瘤的放射治疗,为晚期肿瘤提供了新的治疗方法.我院将三维适形放疗与一体化后装治疗、常规体外放疗及同步化疗相结合,在治疗晚期及复发性宫颈癌方面取得良好的疗效,现报道如下.     

术前新辅助化疗加消瘤放疗用于局部晚期宫颈癌的临床分析

目的:研究新辅助化疗加消瘤放疗后手术治疗ⅠB2～ⅡA期宫颈癌的疗效及意义,评估鳞状上皮细胞癌抗原(SCC)对该治疗方案效果的预测意义。方法:本院2003年1月至2010年6月收治的局部晚期宫颈癌(ⅠB2～ⅡA期)101例,其中研究组(术前同步放化疗组)59例,予铂类为基础的化疗1次联合腔内后装放疗2～3次(700～1200cGy/次),2～3周后行宫颈癌根治术;对照组(同步放化疗组)42例予盆腔内外照射的同步放化疗。比较两种治疗方案的近期疗效,毒副反应及患者生存情况。采用化学发光免疫分析法检测患者血清中SCC水平。结果:两组近期疗效差异无统计学意义,研究组手术切除率达100%,病理有效率93.2%。Kaplan-Meier生存分析显示,研究组及对照组的5年无瘤生存率分别为84.3%和92.8%,5年总生存率分别为87.7%和93.8%,Log rank检验显示,两组的无瘤生存及总生存无统计学差异。新辅助化疗及放疗消瘤后血清SCC阴性者有效率及病理完全反应率较阳性者高,差异均有统计学意义(P<0.05)。结论:在ⅠB2～ⅡA期宫颈癌中,应用新辅助化疗加消瘤放疗后手术疗效与同步放化疗治疗一致,副反应轻,可减少患者痛苦,提高生存质量。血清SCC对术前辅助治疗效果有良好预测作用。     

同步放化疗与新辅助化疗术前用药在局部中晚期宫颈癌治疗中的临床疗效评价

目的:比较同步放化疗与新辅助化疗术前用药在治疗局部中晚期宫颈癌的临床疗效。方法:选择2002年3月至2005年3月我院收治的42例ⅠB2～ⅡB期宫颈癌患者,其中21例同步放化疗,21例新辅助化疗。两组化疗方案相同,鳞癌:顺铂(DDP)+博来霉素;腺癌:DDP+5-氟尿嘧啶(5-Fu)+丝裂霉素(MMC)。同步放化疗组化疗期间配合放疗,采用腔内近距离放疗。同步放化疗、新辅助化疗结束后选择合适时间手术。观察两组间的近期疗效、手术率及手术切缘阴性情况、毒副反应、远期疗效(1、3、5年生存率)。结果:两组间近期疗效差异无统计学意义(P>0.05)、手术率及手术切缘阴性率差异有高度统计学意义(P<0.01)。血液和胃肠道毒副反应差异无统计学意义(P>0.05),晚期并发症放射性直肠炎和膀胱炎差异有高度统计学意义(P<0.01)。1年、3年生存率差异无统计学意义(P>0.05),而5年生存率同步放化疗组高于新辅助化疗组(P<0.05)。结论:同步放化疗术前用药治疗局部中晚期宫颈癌优于新辅助化疗。     

盖诺联合顺铂同步放化疗治疗中晚期宫颈癌42例分析

目的 探讨同步放化疗治疗中晚期宫颈癌的疗效及毒副反应.方法 2002-06-2004-12对温州市第二人民医院同步放化疗组42例中晚期宫颈癌病人用盖诺联合顺铂化疗,同时行根治性放疗;单纯放疗组44例行根治性放疗.结果 同步放化疗组近期有效率92.9%,单纯放疗组77.3%.两组比较差异有显著性意义(P＜0.05),毒副反应相近.结论 同步放化疗治疗中晚期宫颈癌可提高近期疗效,不影响放疗进程,毒副反应无明显增加.     

影响中晚期宫颈癌同步放化疗疗效的临床病理因素分析

目的 探讨影响中晚期宫颈癌同步放化疗疗效的临床病理因素.方法 回顾性分析2000-01-01-2006-12-30广西医科大学肿瘤医院妇瘤科收治的经病理确诊且资料完整的88例接受了首次同步放化疗的ⅡB～Ⅳ期宫颈癌患者的临床资料;同时与同期收治的70例行非同步放化疗的ⅡB～Ⅳ期宫颈癌患者进行对比分析.结果 (1)同步放化疗组的累积生存率:1、3、5年的生存率分别为89.77%、63.91%、50.03%,中位生存期56个月;非同步放化疗组的累积生存率:1、3、5年的生存率分别为90.00%、47.36%、29.09%,中位生存期(34个月),两组比较差异有统计学意义(P=0.005).(2)非同步放化疗患者的复发率(15.71%)高于同步放化疗组(4.55%),差异有统计学意义(P=0.017).(3)顺铂(DDP)增敏化疗的次数、DDP总剂量/总治疗时间比值、外照射放疗(EBRT)总剂量/总治疗时间(OTT)比值是影响中晚期宫颈癌同步放化疗疗效的因素.(4)多因素分析提示肿瘤的病理类型(P<0.1)、DDP总剂量/总治疗时间比值(P<0.05)、EBRT总剂量/OTT比值(P<0.1)是决定预后的独立因素.结论 同步放化疗能改善中晚期宫颈癌患者预后.而肿瘤的病理类型、DDP总剂量/总治疗时间比值和EBRT总剂量/OTT比值是影响其疗效的重要因素.     

宫颈癌术前放射治疗

手术和放疗是子宫颈癌主要治疗手段。局部晚期即预后不良型巨块状宫颈癌及淋巴结转移是影响可手术治疗宫颈癌预后的主要因素。目前,有许多研究认为,术前放疗可以减少肿瘤局部复发,提高存活率。1腔内为主的术前放疗对于ⅠB2期和ⅡA期宫颈癌,肿瘤直径>4cm,具有手术指征的患者,术前应以腔内放疗为主,用以缩小肿瘤,减小肿瘤体积,利于子宫旁及阴道旁的切除,获得切除边缘最宽的无瘤边缘,同时降低肿瘤细胞活性及术中播散,减少局部复发,提高存活率。中国医学科学院肿瘤医院长期以来对ⅠB2期和ⅡA期宫颈癌,肿瘤直径≥4cm,通常给予术前腔内放疗,肿瘤…     

Principles of chemotherapy and radiotherapy

Radiotherapy and chemotherapy are both widely used in the management of gynaecological malignancy. The reasons why tumours are destroyed and normal tissues recover after radiotherapy are complex and poorly understood. Therapeutic effects depend on differences in intrinsic radiosensitivity and the ability to repair and repopulate between normal and malignant tissue. Some tumours contain hypoxic cells, which are a source of radioresistance. At present, most radiotherapy treatments are carried out using a linear accelerator, which produces ‘skin sparing’ radiation and can treat deep-seated tumours. Brachytherapy (short-distance treatment) with implanted or internal radiation sources can also be used, and is an essential part of the radical radiotherapy for cervical carcinoma. Chemotherapeutic agents currently in use are cytotoxic and affect both normal and malignant cells. Side-effects include bone marrow suppression, nausea and vomiting, epilation, renal, cardiac and neurotoxicity. Ideally, agents with different mechanisms of action should be given in combination to overcome potential drug resistance. Multiple drugs should have differing patterns of toxicity so the highest tolerable doses can be given. Chemotherapy can also be given concurrently with radiotherapy to enhance the therapeutic effect. As most gynaecological chemotherapy treatments are palliative, patients should be selected with great care; the possible benefits of the treatment must be balanced against the risk of side-effects.     

Principles of chemotherapy and radiotherapy

The management of most malignancies is multidisciplinary with chemotherapy and radiotherapy widely employed. The reasons tumours are destroyed and normal tissues recover after radiotherapy are complex and thought to be due to differences in intrinsic radiosensitivity and ability to repair and repopulate. Linear accelerators, which produce “skin-sparing” photons (high energy X-rays), are used to treat deep-seated tumours. Brachytherapy (short distance treatment) with implanted or internal radiation sources can also be used.Chemotherapy consists of drugs of different classes and modes of action, which may be used in combination to prevent drug resistance. Cytotoxic agents affect normal and malignant cells leading to a variety of side-effects. Chemotherapy can be given with radiotherapy to enhance the therapeutic effect. With advances in the understanding of the molecular biology of cancer, targeted therapies are now being used in clinical practice. Chemotherapy can be used with curative or palliative intent.     

Postoperative radiotherapy in endometrial adenocarcinoma

We present the results of the association of surgery and radiotherapy in endometrial adenocarcinoma. We have 151 cases of which we know FIGO classification, pTNM, histological grading and myometrium infiltration. Follow-up is considered between 6 months and 10 years. We report the survival graphic lines for a five year period relative to every single prognostic factor.     

Principles of chemotherapy and radiotherapy

Radiotherapy and chemotherapy are both widely used in the management of gynaecological malignancy. The reasons why tumours are destroyed and normal tissues recover after radiotherapy are complex and thought to be due to differences in intrinsic radiosensitivity and the ability to repair and repopulate between normal and malignant tissue. Some tumours are hypoxic, which makes them radioresistant. Most radiotherapy treatments are carried out using a linear accelerator, which produces photons or high energy x-rays that are ‘skin sparing’ and can treat deep-seated tumours. Brachytherapy (short distance treatment) with implanted or internal radiation sources can also be used, and indeed is an essential part of the radical radiotherapy for cervical carcinoma.Chemotherapeutic agents currently in use are cytotoxic and affect both normal and malignant cells. Side-effects include bone marrow suppression, nausea and vomiting, epilation, renal, cardiac and neurotoxicity. Ideally, agents with different mechanisms of action should be given in combination to overcome potential drug resistance. Multiple drugs should have differing patterns of toxicity so the highest tolerable doses can be given. Chemotherapy can also be given concurrently with radiotherapy to enhance the therapeutic effect. Newer biological agents are increasingly being used in the treatment of cancers. As most gynaecological chemotherapy treatments are palliative, patients should be selected with great care; the possible benefits of the treatment must be balanced against the risk of side-effects.     

Principles of chemotherapy and radiotherapy

The current management of all gynaecological malignancy requires complex multidisciplinary investigation and discussion, leading to multi-modality treatment. The delivery of systemic therapy or radiotherapy can have different aims depending on the type of cancer, clinical context and patient wishes. This review explores the systemic treatment options and radiotherapy that form part of the standard management of this group of tumours and looks at current research that may help shape the treatment of the future.     

子宫内膜癌的放射治疗

近年来，随着对子宫内膜癌生物学行为认识的不断深入及放疗技术的不断进步，放疗在子宫内膜癌治疗中发挥着越来越重要的作用，在提高疗效和降低并发症方面都取得了很大进展，但也提出了一些新的问题。