| 王坚,胡莉钧,于波,于静萍,王利利,倪新初,孟庆红,孙志强,汪建林,聂斌.422例宫颈癌患者调强放疗加后装治疗的不良反应和预后因素分析[J].中华放射医学与防护杂志,2019,39(11):807-812 |
| 422例宫颈癌患者调强放疗加后装治疗的不良反应和预后因素分析 |
| Adverse events and prognosis analysis in 422 cervical cancer patients after intensity modulated radiation therapy combined with brachytherapy |
| 投稿时间：2019-09-06 |
| DOI：10.3760/cma.j.issn.0254-5098.2019.11.002 |
| 中文关键词: 宫颈癌 放射治疗 后装 化疗 预后 |
| 英文关键词:Cervical cancer Radiotherapy Brachytherapy Chemotherapy Prognosis |
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| 中文摘要: |
| 目的 观察宫颈癌患者调强放疗+后装治疗±化疗的不良反应和疗效，分析其预后影响因素。方法 回顾性分析徐州医科大学附属江阴临床学院、南京医科大学附属常州市第二人民医院和苏州大学附属第一医院收治的422例接受调强放疗+后装治疗±化疗的宫颈癌患者的临床资料和随访结果，其中同期放化疗353例，单纯放疗69例。Kaplan-Meier法计算总生存（OS）率，Logrank法行预后单因素分析和Cox法行预后多因素分析。结果 同期放化疗与单纯放疗完全缓解（CR）率分别为77.6%和65.2%，两组差异有统计学意义（χ2=4.812，P<0.05）。全组患者1、3和5年OS率分别为93.4%、79.4%和65.0%。年龄、国际妇产科联盟（FIGO）2009分期、淋巴结转移状况、病理类型、放疗同期的化疗情况、近期疗效和序贯化疗情况是影响预后的因素（χ2=6.375~613.123，P<0.05）。多因素分析显示，FIGO分期、淋巴结转移状况、病理类型、放疗同期的化疗情况和近期疗效是影响患者预后的独立因素（χ2=3.930~42.994，P<0.05）。盆腔淋巴结阳性患者行或未行预防性腹主动脉旁淋巴结（PALN）引流区放疗后PALN转移率分别为6.1%和16.8%，差异无统计学意义（P>0.05）；预防性PALN引流区放疗患者的OS高于未行预防性放疗患者（χ2=3.953，P<0.05）。结论 宫颈癌患者采用调强放疗+后装治疗±化疗的治疗模式可取得较好的长期生存。盆腔淋巴结转移患者行预防性PALN引流区放疗有助于改善OS。FIGO分期、病理类型、淋巴结转移状况、是否同期放化疗以及近期疗效是影响患者预后的独立因素。 |
| 英文摘要: |
| Objective To investigate the adverse events and efficacy in cervical cancer patients receiving intensity modulated radiationtherapy (IMRT) plusbrachytherapy with or without chemotherapy, and to indentify the factors that may affect the prognosis. Methods In this retrospective analysis, we analyzed the clinical and follow-up data of the 422 cervical cancer patients,who received IMRT plus brachytherapy with or without chemotherapy.Among these patients,353 cases received concurrent chemoradiotherapy and the other 69 cases received radiotherapy alone. Kaplan-Meier method was utilized to calculate the overall survival (OS) rates. Log-rank-test and Cox regression were performed to executing the univariate and multivariate analysis of the OS, respectively. Results The rate of complete response (CR) in the patients receiving concurrent chemoradiotherapy was significantly higher than that of the patients who received single radiotherapy (77.6% vs. 65.2%, χ2=4.812, P<0.05). The 1-, 3-, and 5-year OS rates were 93.4%, 79.4%, and 65.0%, respectively. Univariate analysis showed that age, Federation International of Gynecology and Obstetr(FIGO)2009 staging, lymph node metastasis, pathological type, chemotherapy experiences concurrent with radiotherapy, short-term efficiency, and sequential chemotherapy could affect the OS (χ2=6.375-613.123, P<0.05). Multivariate analysis showed that FIGO staging, lymph node metastasis, pathological type, chemotherapy experiences concurrent with radiotherapy, and the short-term efficacy were the independent determinants for the prognosis (χ2=3.930-42.994, P<0.05). For patients with positive pelvic lymph node,there were no statistical differences in the para-aortic lymph node (PALN) metastasis whether undergoing prophylactic extended field irradiation of the PALN or not(PALN metastasis rates:6.1% vs. 16.8%, P>0.05). The OS for the patients receiving prophylactic extended field irradiation of the PALN was higher than that of patients without prophylactic radiation (χ2=3.953, P<0.05). Conclusions Cervical cancer patients receiving IMRT plus brachytherapy with or without chemotherapy had achieved promising prognosis. Prophylactic extended field irradiation of the PALN contributed to the improved OS in the patients with pelvic lymph node metastasis. FIGO staging, pathology type, lymph node metastasis, radiotherapy concurrent with chemotherapy or not, and short-term efficiency were independent factors for the prognosis. |
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