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目的观察252Cf腔内后装加盆腔外照射治疗宫颈癌的疗效以及晚期并发症的发生情况,并对治疗方案进行总结。方法选择77例未接受过任何治疗的临床分期为Ⅱa~Ⅳa期的宫颈癌患者作为研究对象,其中Ⅱa期13例,Ⅱb期32例,Ⅲa期18例,Ⅲb期10例,Ⅳa期4例。治疗方案252Cf中子腔内后装治疗,宫旁A点剂量为8~11Gy/次, 1次/周,共进行4~5次,使宫旁A点累积剂量达36~45Gy;该治疗过程中,间歇穿插前后对穿野全盆腔外照射200cGy/次, 4次/周;外照射20~36Gy后,盆腔野中央屏蔽挡铅4cm,继续四野外照射200cGy/次, 4次/周,使盆腔外照射总剂量达到45~50Gy左右。总疗程约需5~6周。结果77例患者随访3年, 3年局部控制率为94% (72 /77); 3年总生存率为82% (63 /77),其中临床分期Ⅱa期为85% (11 /13),Ⅱb期为94% (30 /32),Ⅲa期为78% (14 /18),Ⅲb期为70% (7 /10),Ⅳa期为1 /4。放射性膀胱炎发生率为3%,放射性直肠炎发生率为5%。结论252Cf中子腔内后装加盆腔外照射治疗宫颈癌, 患者能较好耐受,且其Ⅱ、Ⅲ期患者的3年生存率较高而并发症发生率较低,具有较好的应用前景。
Objective To observe the curative effect of 252Cf intracavitary plus pelvic external irradiation in the treatment of cervical cancer and the incidence of late complications and to summarize the treatment plan. Methods A total of 77 patients with cervical cancer who had not received any treatment for stage Ⅱa-Ⅳa were selected as study subjects. Among them, 13 cases were stage Ⅱa, 32 cases were stage Ⅱb, 18 cases were stage Ⅲa, 10 cases were stage Ⅲb, 4 cases were stage Ⅳa . Treatment regimen 252Cf neutron cavity afterloading treatment, uterus A dose of 8 ~ 11Gy / time, 1 / week, a total of 4 to 5 times, so that the cumulative dose of uterine A point 36 ~ 45Gy; the course of treatment , Intermittent perfusion before and after the whole wild-type external pelvic irradiation 200cGy / times, 4 times / week; external beam 20 ~ 36Gy, the pelvic field shielding central block lead 4cm, to continue four field external irradiation 200cGy / time, 4 times / week The total dose of external pelvic radiation reached about 45 ~ 50Gy. The total course of about 5 to 6 weeks. Results The 77 patients were followed up for 3 years. The 3-year local control rate was 94% (72/77). The 3-year overall survival rate was 82% (63/77). The clinical stage IIa was 85% (11/13) 94% (30/32) for stage IIb, 78% (14/18) for stage IIIa, 70% (7/10) for stage IIIb, and 1/4 for stage IVa. The incidence of radiation cystitis was 3%, the incidence of radiation proctitis was 5%. Conclusion 252Cf neutron cavity after posterior plus pelvic external irradiation for the treatment of cervical cancer, patients with better tolerability, and its Ⅱ, Ⅲ patients with higher 3-year survival rate and lower incidence of complications, has a good application prospect.