局部晚期宫颈癌螺旋断层放疗同步化疗早晚期不良反应和疗效观察

目的：分析局部晚期宫颈癌螺旋断层调强（HT）放疗同步顺铂化疗和高剂量率（HDR）腔内照射的早晚期不良反应及疗效。方法选取接受根治性放疗的Ⅰb～Ⅲb宫颈癌患者46例。外照射采用HT-IMRT，14例盆腔淋巴结受累进行勾画定义为GTVnd，临床靶区（CTV）包括盆腔淋巴结区（6例扩大野包括腹主动脉旁淋巴结区），GTVnd、全部子宫、宫颈及阴道，外扩0.8~1 cm构成计划靶区（PTV）。PTV中位剂量50.4 Gy（45～50.4 Gy），常规分割；同步顺铂化疗，40 mg/m2/周；外照射30～40 Gy后联合HDR腔内照射，HDR的A点中位剂量30 Gy （30~36 Gy），总的A点生物等效剂量（EQD2）90.3 Gy（84.9~98.3 Gy)。治疗期间每周及治疗后1~24个月评价不良反应及疗效。结果24例患者完成4～5周期同步化疗，22例患者仅完成2～3周期同步化疗。3级不良反应包括：白细胞减少9例（19.6%），腹泻2例（4.3%），恶心5例（10.9%）及呕吐1例（2.2%）；晚期3级不良反应2例：1例直肠出血，1例膀胱出血；无4级，5级不良反应发生。2年内无复发生存率、无病生存率及总生存率分别为91.7%、86.0%及97.1%。结论局部晚期宫颈癌螺旋断层调强放疗同步每周顺铂化疗联合HDR腔内照射，不良反应以血液学反应和恶心为主，晚期不良反应小，近期疗效较好。

Acute and late toxicities and efficacy of helical tomotherapy and concurrent chemotherapy in the treatment of locally advanced cervical cancer

Objective To investigate the acute and late toxicities and 2-year treatment outcomes in cervical cancer pa-tients underwent helical tomotherapy (HT) with concurrent chemotherapy and high dose afterloading intraluminal brachy-therapy (HDR). Method 46 patients with cervical cancer of stage Ib-IIIb who had accepted radical radiotherapy were en-rolled in the study. HT-IMRT was utilized as the external irradiation. 14 patients with pelvic lymph nodes involvement were outlined and defined as GTVnd, and then clinical target volume included pelvic lymph nodes (6 patients received ex-tended-field irradiation), GTVnd, whole uterus, cervix and vagina, with an extent of 0.8~1 cm as the planning target vol-ume (PTV). The median prescribed dose for PTV was 50.4 Gy (45-50.4 Gy) at 1.8-2.0 Gy per fraction;All patients re-ceived concurrent chemotherapy with cisplatin at 40 mg/m2/w;After HT at 30-40 Gy, HDR was applied in combination, with a median dose of 30 Gy (30-36 Gy) at point A, and the overall equivalent 2 Gy dose (EQD2) was 90.3 Gy (84.9~98.3 Gy) at point A. Adverse reactions and efficacy were evaluated during treatment and 1~24 months thereafter. Result 24 patients completed 4-5 cycles of concurrent chemotherapy and 22 patients completed 2-3 cycles. Acute toxicities of grade 3 included: leukopenia, diarrhea, nausea and vomiting, each occurred in 9 (19.6%), 2 (4.3%), 5 (10.9%), and 1 (2.2%) patients, respectively. Late toxicities of grade 3 occurred in 2 patients, including 1 case with rectal bleeding and an-other 1 case with bladder bleeding. No grade 4 or 5 toxicities were observed. The 2-year recurrence-free survival, disease-free survival and overall survival were 91.7%, 86.0% and 97.1%, respectively. Conclusion Helical tomotherapy with concurrent chemotherapy and high dose afterloading intraluminal brachytherapy mainly causes leukopenia and nausea, which was a feasible therapy with minor late toxicities and satisfactory short-term efficacy.