局部晚期宫颈癌同步放化疗早期疗效评估的临床应用价值

发布时间：2018-01-06 19:06

本文关键词：局部晚期宫颈癌同步放化疗早期疗效评估的临床应用价值　出处：《广西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究背景:宫颈癌(cervical cancer)是妇科最常见的恶性肿瘤之一,发病人数位居所有恶性肿瘤第4位,近年来其发病率呈现出明显的年轻化趋势,原位癌与浸润癌高发年龄均有所降低。目前研究已证实宫颈癌主要与人乳头状瘤病毒(HPV)感染、早婚、早育、多产及性生活紊乱等多种因素密切相关。每年新发病人数530,000例,同时有270,000例死亡,是女性面临的主要健康问题[1-4]。作为发展中国家癌症死亡的主要原因,85%的宫颈癌病例发生在这些地区。一项针对全国29个省、市、自治区的流行病学调查报告显示,宫颈癌死亡率高居我国所有恶性肿瘤的第四位,占女性癌症的第二位[4]。以40岁到50岁为最多发病年龄。宫颈癌病人的治疗措施中约70%以上包括放射治疗,放射治疗适用于所有期别的宫颈癌病人。局部晚期(ⅠB2、ⅡA2、ⅡB、ⅢB、ⅣA)宫颈癌首选同步放化疗。宫颈癌放疗包含体外放疗(external beam radiotherapy,EBRT)与近距离放疗(brachytherapy,BT)。EBRT与BT所针对的照射区域不同,前者主要是照射宫旁区域几淋巴引流区,后者则主要照射原发病灶,单独采取某一种放疗方法很难达到预期效果,只有将两者结合起来才能达到最佳的病灶控制率。随着技术、设备等发展,宫颈癌的放疗从传统的二维全面向基于CT、MRI、PET/CT的三维精确放疗治疗发展。传统的EBRT多采用前后野或四箱野盆腔照射,优点是保证了靶区内放疗剂量分布的均匀性,但缺点是照射野中正常组织接受的剂量与肿瘤组织是一样多的,因此限制了靶区剂量的提高,从而影响疗效。精确放疗的优点是提高靶区放疗剂量同时最大程度的减少正常组织受照射的剂量,从而提高放疗效果。传统的bt是建立在二维基础上的放疗剂量分析,并以icru-38号报告剂量参考点为基础进行剂量评估。对于直径5cm的宫颈局部肿瘤,处方剂量线无法完全包绕肿瘤靶区,从而导致肿瘤照射剂量不足;对于直径≤5cm的宫颈局部肿瘤,处方剂量线包括了部分周围正常组织,导致副反应的增加;同时该体系中设定的a点在治疗中因为肿瘤的变化及每次施源器位置的差异,会导致a点无法无重合,从而a点剂量不确定。因此bt也已向精确的三维近距离治疗发展。临床工作中会发现有些宫颈癌放疗病人对射线敏感,这些敏感的病人放疗预后要明显优于对放疗部分敏感或不敏感的病人。对于放疗不敏感的病人是选择继续放疗还是手术或化疗或姑息治疗目前尚无标准治疗方案。何时评估放疗效果?采用什么标准?目前尚无定论。本研究回顾性分析放疗期间有早期评估的局部晚期宫颈癌的临床病例资料,对比不同放疗效果病人的预后,探讨放疗期间疗效评估的最佳时间、疗效评估的标准及对不同放疗效果病人个体化治疗的策略。研究目的:探讨局部晚期宫颈癌同步放化疗早期疗效评估的临床应用价值,以便为宫颈癌病人个体化治疗临床决策提供依据。研究方法:回顾性分析2011年1月-2013年11月在我院初治、符合纳入标准的iib-iiib宫颈癌病人54例,所有病例均按照国际妇产科联盟(figo,2009)修订的标准进行临床分期,均经宫颈活检病理确诊,除1例病人有轻度肾功能不全外,均无明显血常规、心、肝、肺功能异常。其中iib期病人9例,iiia期病人4例,iiib期病人41例,均为宫颈鳞癌。所有病人均行三维适型调强放疗+腔内后装近距离放射治疗+铂类增敏化疗。所有病例均在外照射30gy行盆腔ct扫描+增强评估宫颈病变的大小。放化疗毒副反应予对症处理。治疗结束后进行定期门诊复查和随访,统计病人预后(pfs、os)。研究结果:在局部晚期宫颈癌病人中,figo分期可以影响局部晚期宫颈癌同步放疗早期效果(P0.05),而年龄、肿瘤的大小(放疗前)、肿瘤分化程度、淋巴结转移情况等临床病理参数与放疗早期评估疗效没有显著相关性。局部晚期宫颈癌同步放化疗早期评估可能对患者的PFS有一定的指导意义,而对于患者的OS的意义并不大。研究结论:FIGO分期在局部晚期宫颈癌同步放疗早期评估中对病人的个体化治疗具有较好的临床价值。我们仍需进一步观察,为宫颈癌的治疗提供一个可行有效的方法。本课题将通过对局部晚期宫颈癌同步放化疗早期评估病人进行分组,其放化疗早期评估可能对患者的PFS有一定的指导意义,而对于患者的OS的意义并不大,应在早期疗效评估后进行个体化治疗,最大可能的提高病人的预后和生存质量。
[Abstract]:Background: cervical cancer (cervical cancer) is one of the most common gynecologic malignant tumor, the incidence of malignant tumors in all fourth, the incidence rate showed a significantly younger trend in recent years, carcinoma in situ and invasive cancer incidence age were decreased. The current study has confirmed that cervical cancer and human papilloma virus (HPV) infection, early marriage, early childbearing, various factors of fertility and sexual disorders are closely related. The annual incidence of 530000 cases, and 270000 cases of death, is a major health problem facing women as the main reason for the development of [1-4]. Chinese home death of cancer, 85% cervical cancer cases occur in these areas. According to a the country's 29 provinces, city, autonomous region survey report shows that cervical cancer mortality rate of all malignant tumors in China fourth, accounting for second of [4]. women's cancer at the age of 40 to 50 years of age the most The age of onset. About 70% of patients with cervical cancer treatment including radiotherapy, radiotherapy for cervical cancer patients. All other locally advanced (B2 I, II A2, B II, B III, IV A) cervical cancer preferred concurrent chemotherapy and radiotherapy for cervical cancer. External beam radiotherapy (including external radiotherapy. EBRT) and brachytherapy (brachytherapy, BT).EBRT and BT in the irradiated area is different, the former is irradiated parametrial area a few lymphatic drainage area, the latter mainly illuminated the primary focus, take a kind of radiation method is difficult to achieve the desired effect, only the combination can achieve the best the lesion control rate. With the development of technology, equipment, radiotherapy of cervical cancer from traditional two-dimensional to three-dimensional based on CT, MRI, precise radiotherapy in the treatment of PET/CT. The traditional EBRT with four boxes of wild or wild before and after pelvic irradiation, the advantages is the guarantee The dose distribution in the target area uniformity, but the disadvantage is the dose irradiation in normal tissue and tumor tissue is accepted as much, thus limiting the target dose increase, thus affecting the curative effect. The advantages of precise radiotherapy is to improve target dose and minimize the dose of normal tissue irradiated thus, to improve the effectiveness of radiotherapy. Traditional BT is based on two-dimensional analysis of radiation dose on the basis of the report and the icru-38 dose reference point as the basis for dose assessment. For the tumor diameter of 5cm, the prescription dose line cannot be completely wrapped around the tumor target, resulting in insufficient tumor dose for cervical cancer; less than 5cm, the prescription dose line includes part of the surrounding normal tissue, resulting in the increase of side effects; at the same time set in the system of a in the treatment of tumors and because of changes in each application The difference is the location of the source, can cause a to overlap, thus a point dose uncertainty. So BT has to accurate 3D brachytherapy. The clinical work will find some cervical cancer patients undergoing radiotherapy on X-ray sensitive, these sensitive radiotherapy prognosis was significantly better than that of radiotherapy on some sensitive or not sensitive the patient is not sensitive to radiotherapy. The patients choose to continue radiotherapy or surgery or chemotherapy or palliative treatment there is no standard treatment. When evaluating radiotherapy effect? What is the standard? Is unclear. This study retrospectively analyzed the early evaluation of radiotherapy for locally advanced cervical cancer clinical data and prognosis of different radiotherapy effect the patient, the best time of radiotherapy efficacy, efficacy evaluation criteria and treatment strategies of different radiotherapy individual patients. The purpose of the study is to explore Locally advanced cervical cancer radiotherapy and chemotherapy efficacy evaluation of early clinical value, so as to provide basis for clinical treatment of patients with cervical cancer. Individual decision research methods: retrospective analysis of January 2011 -2013 year in November in our hospital treatment, in accordance with the inclusion criteria of iib-iiib cervical cancer 54 cases, all cases were in accordance with the International Federation of gynecology and Obstetrics (FIGO, 2009) revised standards for clinical stage were treated by cervical biopsy, except 1 cases of patients with mild renal insufficiency, there were no obvious blood, heart, liver, lung function abnormalities. Among 9 cases of IIB patients, 4 cases of IIIA patients, 41 cases of IIIB patients were. Cervical squamous cell carcinoma. All patients underwent three-dimensional conformal intensity-modulated radiotherapy plus intracavitary brachytherapy plus platinum chemotherapy. All cases were enhanced in the radiotherapy of 30Gy underwent pelvic CT scan and evaluation of cervical lesion size. The toxicity of chemotherapy to put on Symptomatic treatment. Regular review and follow-up after the end of treatment, the statistical prognosis of patients (PFS, OS). Results: in patients with locally advanced cervical cancer, FIGO staging can affect the early effect of radiotherapy in locally advanced cervical cancer (P0.05), and age, tumor size (before radiotherapy), tumor differentiation. There was no significant correlation between lymph node metastasis and clinical pathological parameters and assess the curative effect of early radiotherapy. Concurrent chemoradiotherapy for locally advanced cervical cancer early evaluation may have certain guiding significance for patients with PFS, and for patients with OS significance. Conclusions: FIGO staging in locally advanced cervical cancer radiotherapy for early assessment of patients the individualized treatment has a good clinical value. We still need further observation, provide a feasible and effective method for the treatment of cervical cancer. This study will be based on the synchronization of locally advanced cervical cancer Put the group in early evaluation of chemotherapy patients, the chemotherapy and early evaluation may have a certain guiding significance for patients with PFS, and for patients with OS significance, should be individualized treatment in the early curative effect evaluation, prognosis and survival quality of patients increased the maximum possible.

【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

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