同步放化療治療中晚期宮頸癌 - 看病藥典

作者：劉少兵，周祖金，陳森，覃瑞萍

【摘要】目的觀察化療聯合放療治療中晚期宮頸癌的臨床療效和毒副作用。方法 58例中晚期宮頸癌患者隨機分成化放組（29例）及單純放療組（29例），化放組採用順鉑25mg/m2 d13，靜脈點滴，5Fu 350mg/m2 d15靜脈點滴，每4周重複，共3個周期，同時進行根治性放療，化療第1天開始進行放射治療。用10MVX線體外全盆照射DT38～40Gy，中間鉛擋後照射致宮旁劑量DT50～55Gy，第3周開始行192Ir腔內照射，6Gy/次/天/周，A點劑量6Gy，B點劑量5Gy，共6～7次。單純放射治療組僅行單純放療，方法同化放組，不行化療。結果於放療結束時兩組有效率分別為96.6%及86.2%，差異無顯著(P＞0.05)。放療後3個月時兩組的有效率分別為96.6%及65.5%，差異顯著(P＜0.05)。放化組3、5年生存率和無瘤生存率分別為79.3%、68.9%、62.1%，高於單放組的62.1%、51.7%、41.4%，差異顯著(P＜0.05)，隨訪5年，化放組的盆腔復發率為17.2%，低於單放組的31.0%，P＜0.05。化放組有較明顯的骨髓抑制和消化道反應，但患者經治療後均可耐受。結論化療聯合放療治療中晚期宮頸癌可增強療效，副作用稍增加，但患者能耐受。
【關鍵詞】宮頸癌；同步放化療；療效；副作用
　　Prospective Trial for Concurrent Chemoradiotherapy Treatment in Mediumterm and Advanced Cervical Carcinoma
　　Abstract：Objective To investigate the clinical curative effects and side effects of chemoradiotherapy for mediumterm and advanced cervical carcinoma. Methods FiftyEight patients of mediumterm and advanced cervical carcinoma were randomly divided into two groups: chemoradiotherapy groups and only radiotherapy group. Each patients of the chemoradiotherapy group was given cisplatin at the dose of 25 mg/m2 ivgtt d13 ,5Fluorouracil,350mg/m2 ivgtt,d15, repeat every 28 days, total 3 cycles. And radiotherapy was give at the same time, 10 MVX ray was used for external radiation with a total dose of 38～40 Gy；then the middle field is shielded by plumbum, continuous radiotherapy to total dose of 50～55 Gy; 192Ir highdoserate after loading unit was used for branchytherapy after 3 weeks of external radiotherapy at the dose in A point of 6 Gy per time for total 6～7 times. The patients of radiotherapy group were only received radiotherapy with the same dose and same methods. Results The effect rates of the chemoradiotherapy group and radiotherapy group were 96.6% and 86.2% respectively at the end of the radiotherapy with no difference significantly (P>0.05); Three months after radiotherapy the effect rates in both groups were 96.6% and 65.5%，showing a significant difference (P<0.05). The overall 3year，5year survival rates for the patients in chemoradiotherapy group and radiotherapy group were 79.3%，68.9% and 62.1%，51.7% respectively，P<0.05. Diseasefree survival rates were 62.1% and 41.4% respectively, P<0.05. Pelvic recurrence rates were 31.0% and 17.2% respectively P<0.05. More serious side effects were found in the chemoradiotherapy group. Especially in bone marrow inhibition and reaction of digestive tract, Which could be alleviated. Conclusion Concurrent chemotherapy and radiotherapy in mediumterm and advanced cervical carcinoma can increase treatment effect and raise the survival of the patients ,obviously improve the shortterm curative effect. Toxicity of patients was increasing but the patients could tolerate.
　　Key words：Cervical cancer；Concurrent chemoradiotherapy；Theraputic effect；Adverse effect
　　0 引言
宮頸癌的治療主要為手術治療和放射治療，早期以手術為主，Ⅱb期以後主要選擇放射治療，雖然近10餘年來放療技術不斷改進，但單純放射治療其5年生存率沒有明顯提高，其主要原因為局部復發和遠處轉移。近幾年化療在宮頸癌中的應用逐漸得到重視，放療聯合化療在中晚期宮頸癌的研究和應用亦取得一定的進展，放療與化療同步治療也越來越受到人們的重視。我科於1999年6月～2000年8月對58例Ⅱb及Ⅲb期宮頸癌患者隨機分成兩組，分別採用化放同步治療(放化組)和單純放療(單放組)，比較兩組的療效和毒副作用，現報告如下：
　　1 資料與方法
　　1.1 一般資料
所選病例均為來我院初診並經病理確診的58例Ⅱb期及Ⅲb期宮頸癌患者。根據1994年FIGO標準進行臨床分期［1］，年齡22～70歲，中位年齡50歲，卡氏評分≥70，無明顯肝、肺功能異常。所有患者通過信訪和門診定期複查得到隨訪結果。隨訪時間為18～60個月，中位隨訪期為46個月，失訪1例，隨訪率98.3%，58例患者隨機分為化放組及單純放療組，兩組臨床資料，見表1。表1 兩組患者臨床資料比較（略）
　　1.2 治療方法
兩組根治性放療均採用盆腔外照射加腔內後裝治療。具體方法採用10MVX線機體外全盆照射，照射野上界於第5腰椎上緣，下界為閉孔下緣，兩側界為超過真骨盆外1cm，常規分割照射，盆腔組織劑量為38～40Gy後改全盆大野中間鉛擋，照射致宮旁組織量為50～55Gy，在全盆野照射2周後開始行腔內後裝治療，採用192Ir源HYHDR18型高劑量率後裝機，1次/周，宮腔和陰道分別進行治療(先宮腔管後陰道穹窿球)，陰道和宮腔劑量比為1∶1.5，置放施源器後經定位、攝片，TPS制定個體治療計劃，A點參考劑量為6Gy，總劑量30～36Gy，腔內後裝治療當天停止外照射。化放綜合組採用DF方案化療：順鉑25 mg/m2，第1～3d靜脈點滴，5Fu：350mg/m2，第1～5d靜脈點滴，4周為一個療程，共3個周期，放療一開始就同時進行化療，放化療期間用格拉司瓊止吐，監測血像，用惠爾血升白治療。