| 李小凡,李永恒,苏星.宫颈癌初始治疗后腹主动脉旁淋巴结转移调强放疗的临床观察[J].中华放射医学与防护杂志,2015,35(7):522-527.Li Xiaofan,Li Yongheng,Su Xing.Clinical analysis of intensity modulated radiation therapy in cervical cancer patients with para-aortic lymph node metastasis after initial treatment[J].Chin J Radiol Med Prot,2015,35(7):522-527 |
| 宫颈癌初始治疗后腹主动脉旁淋巴结转移调强放疗的临床观察 |
| Clinical analysis of intensity modulated radiation therapy in cervical cancer patients with para-aortic lymph node metastasis after initial treatment |
| 投稿时间：2015-04-21 |
| DOI：10.3760/cma.j.issn.0254-5098.2015.07.010 |
| 中文关键词: 宫颈癌 腹主动脉旁淋巴结转移 调强放疗 TP方案化疗 |
| 英文关键词:Cervical cancer Para-aortic lymph node metastases Intensity modulated radiation therapy TP regimen chemotherapy |
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| 中文摘要: |
| 目的 对比单纯调强放疗(IMRT)与IMRT同步TP方案化疗治疗宫颈癌初始治疗后腹主动脉旁淋巴结(PALN)转移的疗效和不良反应。方法 选取2008年10月至2013年8月宫颈癌初始治疗后出现PALN转移的56例患者,PALN转移病灶给予放疗剂量GTV 55~60 Gy,CTV 45~50 Gy,共25~30次,5~6周,接受同步放化疗(CRT组)者36例,单纯放疗(RT组)者20例。CRT组的同步化疗方案为TP方案,第1天紫杉醇135 mg/m2,顺铂60 mg/m2 2 d,21 d重复。单纯PALN转移(iPALN)患者33例,合并其他部位复发转移(niPALN)患者23例。结果 中位随访时间22.7个月(2.7~74.4个月)。98.2%(55/56)的患者完成了放疗,CRT组中,38.9%的患者完成化疗2~3个周期,61.1%的患者完成化疗1个周期。CRT和RT组的有效率(CR+PR)分别为91.7%(33/36)和85%(17/20)(χ2=0.516,P > 0.05)。两组患者的中位总生存(OS)时间为38和23个月,3年OS率分别为57.5%和32.7%(χ2 =4.059,P < 0.05),中位无进展生存时间(PFS)为68.3和16个月,3年PFS率分别为50.4%和29.2%(χ2=4.184,P < 0.05)。单纯PALN转移(iPALN)(33例)患者与合并其他部位复发转移(niPALN)患者(23例)的中位OS分别为71.2和21.4个月,3年OS率分别为53% 和39.5%(χ2=4.265,P < 0.05)。CRT和RT组出现3或4级白细胞低下的患者分别为10例(27.8%)和6例(30%),3级消化道反应各有1例,差异均无统计学意义(χ2=0.693、0.847,P > 0.05)。结论 IMRT同步TP化疗对PALN转移的患者近期效果和远期生存均优于单纯放疗的患者,且不良反应可耐受。 |
| 英文摘要: |
| Objective To evaluate the efficacy and toxicities of intensity modulated radiation therapy (IMRT) with or without concurrent chemotherapy in the treatment of cervical cancer patients with para-aortic lymph node (PALN) metastases after initial treatment. Methods From Oct 2008 to Aug 2013, 56 cervical cancer patients with PALN metastases after initial treatment, including radical resection or pelvic radiotherapy/chemoradiotherapy, were selected for analysis. The delivered radiation dose to PALN was 55-60 Gy for GTV and 45-50 Gy for CTV respectively with 25-30 fractions during 5-6 weeks. 36 patients received concurrent paclitaxel (135 mg/m2) and cisplatin (60 mg/m2) chemoradiotherapy (CRT group) and 20 patients received RT alone (RT group). Results The median follow-up time after treatment was 22.7 months (2.7 to 74.4 months). 98.2% (55/56) of patients completed RT. In CRT group, 38.9% underwent concurrent TP regimen 2-3 cycles and the rest completed one cycle. The rates of CR plus PR in CRT and RT groups were 91.7% (33/36) and 85% (17/20), respectively (χ2 =0.516,P > 0.05). The 3-year overall survival rate in CRT group and RT group were 57.5% and 32.7% (χ2 =4.059,P < 0.05), and 3-year progression-free survival rates were 50.4% and 29.2%(χ2 =4.184,P < 0.05), respectively. TP regimen concurrent chemoradiotherapy was more effective than radiotherapy alone. The 3-year overall survival rate was 53% and 39.5% in patients with isolated PALN and nonisolated PALN, respectively (χ2 =4.265,P < 0.05). Grade 3 or 4 acute leukopenia was found in 10 (27.8%, CRT group) and 6 (30%, RT group) patients (χ2 =0.693,P > 0.05). Grade 3 gastrointestinal toxicity occurred in 1 patient each group (χ2 =0.847,P > 0.05). Conclusions TP regimen concurrent CRT is associated with better survival than RT alone, and the treatment toxicities could be tolerant. |
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