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背景与目的:宫颈癌是一种严重危害妇女健康的恶性肿瘤。放疗是主要治疗手段,宫颈癌的放疗多以内照射加外照射。内照射国内外多采用192Ir或137Cs高剂量率γ射线腔内后装治疗。252锎(C f)近距离治疗妇科恶性肿瘤开始于20世纪60年代后期。本文旨在观察252锎(C f)腔内后装加盆腔外照射治疗子宫颈癌的疗效以及并发症的发生情况,并对治疗方案进行总结。方法:43例未接受过任何治疗的子宫颈癌患者中,Ⅱa期5例,Ⅱb期24例,Ⅲa期9例,Ⅲb期5例。均采用252锎(C f)腔内后装和盆腔外照射同时进行的方法治疗。其中,中子腔内后装治疗,宫旁A点剂量为8~12Gy/次,1次/周,共进行4~5次,使宫旁A点累积剂量达30~40Gy;60Coγ射线外照射,全盆腔野前后对穿照射,B点每次吸收剂量2Gy/次,4次/周,5~7周,外照射25~30Gy后改前、后四野至总剂量40~50 Gy。腔内照射当日不行体外照射,中子治疗第二天开始外照射,全程总剂量70~80Gy。结果:43例患者随访3年,2年局部病灶控制率为100%(43/43),2年总生存率为93.0%(40/43);3年局部病灶控制率为93.0%(40/43),3年总生存率为88.4%(38/43)。远期并发症:阴道挛缩、粘连4.6%(2/43),迁延型放射性直肠炎发生率为2.3%(1/43)。结论:252锎(C f)中子腔内后装放射加盆腔外照射治疗宫颈癌,患者能较好耐受,且具有局部病灶控制率高、并发症发生率低等特点,具有一定临床应用前景。
Background and Objective: Cervical cancer is a malignant tumor that seriously endangers women’s health. Radiation therapy is the main treatment, radiotherapy of cervical cancer more than within the irradiation plus external irradiation. Internal irradiation and more use 192Ir or 137Cs high dose rate γ-ray intracavity after treatment. 252 锎 (C f) Brachytherapy of gynecological malignancies began in the late 1960s. This article aims to observe the 252 锎 (C f) after posterior plus extra-pelvic irradiation for the treatment of cervical cancer and the incidence of complications, and treatment options are summarized. Methods: Among 43 patients with cervical cancer who had not received any treatment, there were 5 cases of stage Ⅱ a, 24 cases of stage Ⅱ b, 9 cases of stage Ⅲa and 5 cases of stage Ⅲb. Both 252 锎 (C f) intracavitary and post-pelvic irradiation simultaneously with the method of treatment. Among them, the neutron cavity after treatment, uterine A dose of 8 ~ 12Gy / time, 1 times / week, a total of 4 to 5 times, so that the cumulative dose of uterine A point up to 30 ~ 40Gy; 60Co γ ray external beam irradiation , The whole pelvic field before and after wearing radiation, B point each dose 2Gy / times, 4 times / week, 5 to 7 weeks, 25-30 Gy external irradiation after the change before and after the four fields to a total dose of 40 ~ 50 Gy. Intraluminal irradiation on the day no external irradiation, neutron therapy began the second day of external irradiation, the total dose of 70 ~ 80Gy. Results: 43 patients were followed up for 3 years. The 2-year local control rate was 100% (43/43) and the 2-year overall survival rate was 93.0% (40/43). The 3-year local control rate was 93.0% 43). The 3-year overall survival rate was 88.4% (38/43). Long-term complications: vaginal contracture, adhesions 4.6% (2/43), delayed proctitis was 2.3% (1/43). Conclusion: 252 锎 (C f) neutron cavity after posterior radiation and pelvic external irradiation for the treatment of cervical cancer, the patient can be well tolerated, and with local control of high rates of complications and low incidence, with some clinical applications prospect.