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目的:探讨CT引导下加速超分割三维后装放疗结合体外照射治疗局部晚期宫颈癌的临床疗效及合并症。方法:选取2007-08-28-2010-08-09中山大学肿瘤防治中心放疗科46例初治局部晚期宫颈癌患者,体外照射采用四野盒式照射,20Gy后开始CT引导下的三维后装放疗,采用组织间插植结合腔内放疗,高危靶体积(high risk clinical taget volume,HRCTV)D90处方剂量5Gy/次,2次/d,4d完成,继续后续的体外照射。结果:HRCTV D90为79.05Gy,膀胱D2cc为80.85Gy,直肠D2cc为65.05Gy,乙状结肠D2cc为65.80Gy。放疗结束后1~3个月肿瘤完全缓解率为93.48%(43/46),3年局部控制率为86.96%(40/46),3年远处转移率为17.39%(8/46),3年总生存率为89.13%(41/46)。急性反应有3级肠炎1例,2级肠炎5例。慢性放疗反应主要为便血,无3级以上放疗相关的合并症。结论:三维CT引导下加速超分割后装放疗结合体外照射治疗局部晚期宫颈癌疗效确切,快捷安全,值得推广。
Objective: To investigate the clinical efficacy and complications of CT-guided accelerated hyperfractionated three-dimensional posterior radiation combined with external beam irradiation in the treatment of locally advanced cervical cancer. Methods: Forty-six patients with newly diagnosed locally advanced cervical cancer undergoing radiotherapy at Cancer Center of Sun Yat-sen University from August 2007 to August 2008 were enrolled in this study. Four-field cassette irradiation was used for external irradiation. Three-dimensional CT-guided radiotherapy was started after 20 Gy , And interstitial implantation combined with intracavitary radiotherapy. The dose of high-risk clinical taget volume (HRCTV) D90 was 5 Gy / time, 2 times / d and 4 days, and the subsequent in vitro irradiation was continued. Results: HRCTV D90 was 79.05Gy, bladder D2cc was 80.85Gy, rectum D2cc was 65.05Gy, sigmoid colon D2cc was 65.80Gy. The complete remission rate was 93.48% (43/46) between 1 and 3 months after radiotherapy. The 3-year local control rate was 86.96% (40/46), and the 3-year distant metastasis rate was 17.39% (8/46) The 3-year overall survival rate was 89.13% (41/46). Acute reactions have grade 3 enteritis in 1 case, grade 2 enteritis in 5 cases. Chronic radiation therapy mainly for the blood in the stool, no more than 3 radiotherapy-related complications. Conclusion: The three-dimensional CT guided accelerated hyperfractionated radiotherapy combined with external beam irradiation for the treatment of locally advanced cervical cancer is effective, quick and safe and worthy of promotion.