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目的:探讨三维适型调强放疗(IMRT)结合常规放疗加同步化疗治疗局部晚期外阴鳞癌患者的近期疗效及放化疗并发症的发生情况。方法:25例局部晚期外阴鳞癌患者,随机分为三维适型调强放疗结合常规放疗加同步化疗组(调强组)10例,常规放疗组(常规组)15例。调强组针对外阴及双侧腹股沟淋巴结病灶采用IMRT放疗DT30 Gy后给予不同能量电子线放疗DT30Gy,放疗期间同步进行顺铂化疗,30 mg/m~2/周,共6周。常规放疗组则采用不同能量的电子线及X线,照射总量为DT60Gy。按WHO对实体瘤近期疗效评价标准进行疗效评价。结果:调强组10例中CR 3例,PR6例,有效率9帆;近期疗效两组差异有统计学意义(P=-0.0405)。两组近期并发症比较,调强组放射性皮肤反应、放射性膀胱炎低于常规组,差异有统计学意义(P=0.0162,P=0.0070)。结论:三维适型调强放疗结合常规放疗加同步化疗治疗局部晚期外阴鳞癌患者近期治疗效果较满意,并且近期并发症中放射性皮肤反应、放射性膀胱炎较常规放疗组低。三维适型调强放射技术在外阴癌放疗小作用仍需大宗病例和长期随访来验证其优越性。
Objective: To investigate the short-term curative effect and the incidence of radiotherapy and chemotherapy complications in patients with locally advanced vulvar squamous cell carcinoma treated by three-dimensional conformal IMRT combined with conventional radiotherapy and concurrent chemotherapy. Methods: Twenty-five patients with locally advanced vulvar squamous cell carcinoma were randomly divided into three groups: 10 cases received stereotactic IMRT combined with conventional radiotherapy plus synchronous chemotherapy (IMRT group) and 15 cases with conventional radiotherapy (conventional group). Tiaoqiang group for vulvar and bilateral inguinal lymph node lesions using IMRT DT30 Gy after treatment with different energy electron beam radiotherapy DT30Gy, cisplatin chemotherapy simultaneously during radiotherapy, 30 mg / m ~ 2 / week for a total of 6 weeks. Conventional radiotherapy group uses different energy of the electronic line and X-ray, the total amount of radiation for the DT60Gy. According to the WHO evaluation of the efficacy of solid tumors in the near future evaluation criteria. Results: In 10 cases of IMRT group, 3 cases were CR and 6 cases were PR. The effective rate was 9 sail. There was significant difference between the two groups in short term efficacy (P = -0.0405). Radiological skin reaction and radiation cystitis in IMRT group were lower than those in routine group (P = 0.0162, P = 0.0070). Conclusion: Three-dimensional CRT and conventional radiotherapy combined with concurrent chemotherapy for the treatment of locally advanced vulvar squamous cell carcinoma are more satisfactory in recent treatment, and the recent complication of radioactive skin reaction and radiation cystitis are lower than conventional radiotherapy group. Three-dimensional adaptive intensity modulated radiation therapy in vulvar cancer radiotherapy small role still need large cases and long-term follow-up to verify its superiority.