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目的探讨不同治疗模式对ⅡB期宫颈癌患者预后和生活质量的影响。方法选取2010年7月至2012年7月间收治的112例ⅡB期宫颈癌患者,根据患者自愿原则及身体状况,分为三维适形放疗(3D-CRT)治疗组(36例)、调强放疗(IMRT)治疗组(38例)及螺旋断层放疗(HT)治疗组(38例)。放疗前后采用放射肿瘤学协作组(RTOG)/欧洲癌症研究与治疗组织(EORTC)标准,对各组患者的直肠和膀胱放疗反应的急性期及晚期反应进行评价与比较。采用宫颈癌患者生命质量测评量表(FACT-CX)进行生活质量评价。结果与3D-CRT治疗组比较,IMRT治疗组和HT治疗组患者的直肠和膀胱1级急性、晚期放疗反应发生率均降低,差异均有统计学意义(均P<0.05)。与IMRT治疗组比较,HT治疗组患者的直肠和膀胱1级急性放疗反应发生率均降低,差异均有统计学意义(均P<0.05)。与3D-CRT治疗组比较,IMRT治疗组和HT治疗组患者的直肠和膀胱晚期放疗反应发生率均降低,差异均有统计学意义(均P<0.05)。与3D-CRT治疗组比较,IMRT治疗组和HT治疗组放疗2年后的生活质量各维度评分均升高,差异均有统计学意义(均P<0.05)。结论 HT和IMRT治疗均减少ⅡB期宫颈癌患者的放疗反应,提高生活质量,但HT在降低急性放疗反应上优势明显。
Objective To investigate the effects of different treatment modalities on prognosis and quality of life of patients with stage ⅡB cervical cancer. Methods A total of 112 patients with stage IIB cervical cancer who were treated between July 2010 and July 2012 were selected and divided into three-dimensional conformal radiotherapy (3D-CRT) group (36 cases) according to their voluntary principles and physical condition. Radiotherapy (IMRT) group (38 cases) and spiral CT group (38 cases). The RTOG / EORTC criteria were used before and after radiotherapy to evaluate the acute and late reactions of rectal and bladder radiotherapy in each group. Quality of life assessment was performed using the FACT-CX quality of life questionnaire. Results Compared with 3D-CRT group, the acute and late stage radiotherapy rates of rectum and bladder decreased in IMRT group and HT group (all P <0.05). Compared with the IMRT group, the incidence of acute grade 1 radiotherapy in the rectum and bladder in the HT group was significantly lower (all P <0.05). Compared with the 3D-CRT group, the incidence of rectal and bladder late radiotherapy in IMRT group and HT group were significantly lower (all P <0.05). Compared with the 3D-CRT group, the scores of quality of life in IMRT group and HT group after 2 years of radiotherapy were all significantly higher (all P <0.05). Conclusion HT and IMRT both reduce the radiotherapy response and improve the quality of life in patients with stage ⅡB cervical cancer, but HT has obvious advantages in reducing acute radiation response.