摘要
目的探讨调强放疗(IMRT)联合腔内后装放疗对宫颈癌靶区、正常组织及肿瘤血管的影响。方法前瞻性选取我院收治的82例宫颈癌患者,采用随机数字表法分为对照组和观察组,每组41例。对照组采用常规四野盒式放疗联合腔内后装放疗,观察组采用IMRT联合腔内后装放疗。比较2组患者疗效,血清肿瘤标志物[癌胚抗原(CEA)、鳞状细胞癌抗原(SCCA)、糖链抗原153(CA153)],靶区及正常器官受量,肿瘤血管形成指标[血清血管内皮生长因子(VEGF)、CD31、血管生成素-2(Ang-2)、低氧诱导因子-1α(HIF-1α)],不良反应发生率,中位无进展生存期(PFS),治疗后6个月、1年总生存率。结果观察组治疗有效率、疾病控制率高于对照组(P<0.05)。观察组CTV、PTV、CTV处方剂量覆盖体积、达100%处方剂量的体积(V100)、达90%处方剂量的体积(V90)高于对照组(P<0.05);观察组小肠、直肠、膀胱、股骨头、骨髓中V30、V45、平均剂量低于对照组(P<0.05);观察组股骨头、骨髓中V10、V20高于对照组(P<0.05)。观察组治疗后2周及1个月CEA、SCCA、CA153、CD31、VEGF、Ang-2、HIF-1α均低于对照组(P<0.05)。观察组泌尿系统、血液系统不良反应发生率均低于对照组(P<0.05);观察组中位PFS长于对照组,1年总生存率高于对照组(P<0.05)。结论IMRT联合腔内后装放疗治疗宫颈癌能提高靶区内放疗剂量,减少危及器官的受照剂量,促进病灶消退,抑制肿瘤血管形成,延长中位PFS,提高1年总生存率,降低不良反应发生率,可作为不能手术宫颈癌患者的一种有效疗法。
Objective To investigate the effect of intensity-modulated radiotherapy(IMRT)combined with intracavitary brachytherapy on cervical cancer target area,normal tissues and tumor blood vessels.Methods A total of 82 cervical cancer patients in our hospital were prospectively selected and divided into the control group and observation group by random number table method,with 41 cases in each group.The control group was treated by conventional four-field radiotherapy combined with intracavitary brachytherapy,and the observation group was treated by IMRT combined with intracavitary brachytherapy.The efficacy,serum tumor markers[including carcinoembryonic antigen(CEA),squamous cell carcinoma antigen(SCCA),carbohydrate antigen 153(CA153)],the radiological dose of the target area and normal organs,tumor angiogenesis indicators[including serum vascular endothelial growth factor(VEGF),CD31,angiopoietin-2(Ang-2),hypoxia inducible factor-1α(HIF-1α)],incidence of adverse reactions,median progression-free survival(PFS),and of 6-month and 1-year overall survival rates were compared between the two groups.Results The treatment efficiency and disease control rate of the observation group were higher than those in the control group(P<0.05).The coverage volume of clinical target volume(CTV),planning target volume(PTV),CTV prescription dose,the volume of 100%prescription dose(V100),and the volume of 90%prescription dose(V90)of the observation group were higher than those of the control group(P<0.05).The V30,V45 and the average dose in the small intestine,rectum,bladder,femoral head,and bone marrow of the observation group were lower than those of the control group(P<0.05).V10 and V20 in the femoral head and bone marrow of the observation group were higher than those of the control group(P<0.05).CEA,SCCA,CA153,CD31,VEGF,Ang-2 and HIF-1α2 weeks and 1 month after treatment in the observation group were lower than those in the control group(P<0.05).The incidences of adverse reactions in the urinary system and blood system of the observation group were lower than those of the control group(P<0.05).The median PFS in the observation group was longer than that in the control group and the 1-year overall survival rate was higher than that in the control group(P<0.05).Conclusion IMRT combined with intracavitary brachytherapy in the treatment of cervical cancer can increase the radiological dose in the target area,reduce the dose of the risk organs,promote the regression of the lesion,and inhibit tumor angiogenesis,prolong the median PFS,increase the 1-year overall survival rate and reduce the incidence of adverse reactions,which can be an effective treatment for patients with inoperable cervical cancer.
作者
白胜江
刘玉涛
赵红
胡云峰
BAI Sheng-jiang;LIU Yu-tao;ZHAO Hong;HU Yun-feng(Department of Oncology,Affiliated Hospital of Yan’an University,Yan’an Shaanxi 716000,China;Department of Infectious Diseases,Affiliated Hospital of Yan’an University,Yan’an Shaanxi 716000,China)
出处
《局解手术学杂志》
2021年第2期146-151,共6页
Journal of Regional Anatomy and Operative Surgery
基金
陕西省医学科学研究重点课题计划(2019JM0998)。
关键词
IMRT
常规放疗
肿瘤血管
腔内后装放疗
正常组织受量
病灶消退
宫颈癌
靶区受量
IMRT
conventional radiotherapy
tumor blood vessel
intracavitary brachytherapy
normal tissue radiological dose
lesion regression
cervical cancer
target area radiological dose
