宫颈癌不同放化疗联合方案的疗效分析及影像引导的近距离放疗的剂量学研究

发布时间：2018-07-02 15:49

本文选题：宫颈癌 + 同步放化疗　；参考：《苏州大学》2015年硕士论文

【摘要】：目的:1、观察和分析宫颈癌患者单纯放疗、同步放化疗、辅助化疗的临床治疗效果以及治疗相关副作用,以评估不同的治疗方案在临床应用中的价值。2、鉴于传统二维后装放疗无法个体化评估不同宫颈癌患者肿瘤和危及器官受照射的剂量体积,采用CT引导的三维适形近距离放射治疗技术治疗中晚期宫颈癌患者,通过比较和分析不同的近距离放疗技术治疗宫颈癌患者肿瘤和危及器官的剂量体积,评价在CT引导下的近距离放疗在宫颈癌放疗中的应用优势和不足,为临床应用和推广该技术提供依据。方法:第一部分选取127例2008年10月至2013年10月于我科行治疗的宫颈癌病人,根据治疗方案分为三组,单纯放疗组45例,放疗联合顺铂周化疗组58例,放疗联合辅助化疗组24例,三组均行根治性放疗,同步放化疗组予放疗同期每周顺铂化疗,辅助化疗组予根治性放疗后紫杉醇+卡铂化疗,比较三组病人的生存率和副作用发生率的差异。第二部分选择2014年2月至2014年12月期间在苏州大学附属第一医院放疗科行根治性放疗的12例中晚期宫颈癌患者为研究对象,采用Phillip 16排螺旋CT模拟机扫描定位,共采集图像59次,根据GEC-ESTRO推荐勾画靶区和危险器官,在Oncentra治疗计划系统上用同样的施源器分别设计二维、三维的治疗计划,比较两种计划的剂量参数。结果:第一部分全组病人均顺利完成治疗,中位随访时间41个月,单纯放疗组获CR24例,PR14 II例,SD4例,PD3例,CR为53.33%;顺铂周化疗组获CR45例,PR8例,SD3例,PD2例,CR为77.59%;辅助化疗组获CR15例,PR6例,SD2例,PD1例,CR为62.50%。三组CR差异有统计学意义(P=0.4960.05)。单纯放疗组、顺铂周化疗组、辅助化疗组的两年总生存率分别为66.2%、85.4%、74.9%,三年总生存率分别为:64.2%、82.4%、74.9%,五年总生存率分别为:54.8%、78.1%、74.9%,两年无进展生存率分别为:57.9%、85.4%、69.3%,三年无进展生存率分别为:56.1%、82.4%、69.3%,差异均具有统计学意义(P0.05)。三组不良反应主要以1-2级为主,其中白细胞、血小板减少、恶心呕吐、膀胱损伤发生具有统计学差异,三级以上放射性直肠损伤发生率为7.09%,三级以上放射性膀胱损伤发生率为0.79%,一旦发生,严重降低患者的生活质量。第二部分三维计划的高危CTV D90最小值、最大值、平均值及中位数明显高于二维计划的D90,三维计划高危CTV D90平均值为(528.06±70.29)c Gy,二维计划高危CTV D90平均值为(425.66±95.94)c Gy。两种计划的D90差异具有统计学意义(P=0.000)。三维计划组与二维计划组膀胱D0.1cm3、D1cm3、D2cm3相比,P值分别为0.824、0.885、0.899,差异均无统计学意义,但三维计划的膀胱D0.1cm3、D1cm3、D2cm3的最大值、最小值、平均值均低于二维计划。在D0.1cm3对比中,二维计划组有11.86%的膀胱剂量超过处方剂量600c Gy,而三维计划组比例为10.17%;在D1cm3对比中,二维计划组有1.69%的膀胱剂量超过处方剂量,而三维计划组为0%。三维计划组与二维计划组直肠D0.1cm3、D1cm3、D2cm3相比,三组的P值分别为0.042、0.031、0.015,P0.05,三组差异均有统计学意义。三维计划的直肠D0.1cm3、D1cm3、D2cm3的最大值、最小值及平均值均低于二维计划。二维计划组直肠D0.1cm3超过处方剂量的百分比为22.03%,而三维计划仅占8.47%;二维计划组直肠D1cm3超500c Gy和处方剂量的百分比分别为18.64%、6.78%,而三维计划分别占5.08%、0%;二维计划组直肠D2cm3超过500c Gy的百分比为6.78%,而三维计划为0%(P0.05)。结论:1、放疗同步联合化疗治疗宫颈癌疗效显著,可提高五年总生存率和无进展生存率,优于单纯放疗和放疗联合辅助化疗,是理想的宫颈癌治疗方法,但也需要注意因同步放化疗引起的治疗相关毒性反应的增加。对于不能耐受同步放化疗的病人,辅助化疗也能取得较单纯放疗更高的生存获益。2、以CT影像为基础的宫颈癌三维腔内放疗计划与常规二维计划相比,能够显著增加肿瘤靶区包绕及受照剂量,可以有效控制高剂量区域内危及器官的体积,有利于降低近距离治疗严重并发症的发生,尤其对于中晚期病人,肿块较大,肿瘤靶区与危及器官关系复杂等情况时优势更明显。但三维腔内放疗发展时间较短,经验有限,需要和传统二维技术相比较,不断总结经验,提高疗效,降低副反应,提高患者的生活质量。
[Abstract]:Objective: 1, to observe and analyze the clinical efficacy and side effects of radiotherapy, concurrent chemoradiotherapy, adjuvant chemotherapy and treatment for cervical cancer patients, in order to evaluate the value of different treatments in the clinical application of.2. Volume volume, CT guided three-dimensional conformal near range radiation therapy for patients with advanced cervical cancer, by comparing and analyzing the different dose of near range radiotherapy for cancer patients and endanger organs, evaluate the advantages and disadvantages of the application of CT guided radiation therapy in the radiotherapy of cervical cancer. The first part selected 127 cases of cervical cancer treated by our department from October 2008 to October 2013. According to the treatment scheme, the patients were divided into three groups, 45 cases were treated with radiotherapy alone, 58 cases with radiotherapy combined with cisplatin chemotherapy group, 24 cases with radiotherapy combined with adjuvant chemotherapy group, and all the three groups were treated with radical radiotherapy and synchronous radiotherapy and chemotherapy group. Radiotherapy was treated with cisplatin chemotherapy for the same period, and adjuvant chemotherapy group was treated with paclitaxel plus carboplatin chemotherapy after radical radiotherapy. The difference of survival rate and side effect rate between the three groups was compared. The second part selected 12 cases of middle and advanced cervical cancer patients in the Radiotherapy Department of First Hospital Affiliated to Suzhou University from February 2014 to December 2014. The study object, using the Phillip 16 row spiral CT simulation machine scanning location, collects the image 59 times, according to the GEC-ESTRO recommends the target area and the dangerous organ, in the Oncentra treatment plan system, uses the same application source to design the two dimensional, three-dimensional treatment plan respectively, and compares the two kinds of planning dose parameters. After 41 months of follow-up, the median follow-up period was 41 months, the radiotherapy group received CR24, PR14 II, SD4, PD3, and CR 53.33%, and cisplatin week chemotherapy group received CR45, PR8, SD3, PD2, CR 77.59%. The total survival rate of the chemotherapy group was 66.2%, 85.4%, 74.9%, and the total survival rate of three years were 64.2%, 82.4%, 74.9% and five years respectively: 54.8%, 78.1%, 74.9%, respectively: 57.9%, 85.4%, 69.3%, respectively, respectively. (P0.05). Three groups of adverse reactions were mainly grade 1-2, of which white blood cells, thrombocytopenia, nausea and vomiting, bladder injury were statistically different, the incidence of radioactive rectal injury above three levels was 7.09%, and the incidence of radioactive bladder injury above three levels was 0.79%. Once it occurred, the quality of life of the patients was severely reduced. Second parts three were severely reduced. The minimum value, maximum value, average value and median of the high risk CTV D90 were significantly higher than the D90 of the two dimensional plan. The average value of the high risk CTV D90 of the three dimensional plan was (528.06 + 70.29) C Gy, the average value of the high risk CTV of the two dimensional plan was (425.66 + 95.94) C Gy., and the D90 difference of the two plans was statistically significant. The P values of the bladder D0.1cm3, D1cm3, and D2cm3 were 0.824,0.885,0.899, respectively, and the difference was not statistically significant, but the maximum, minimum, and average value of the bladder D0.1cm3, D1cm3, D2cm3 in the three dimensional plan were lower than the two dimensional plan. In the D0.1cm3 contrast, 11.86% of the two dimensional plan group had a bladder dose exceeding the prescribed dose 600C Gy, and the ratio of the three dimensional plan group. For 10.17%, in the D1cm3 contrast, 1.69% of the bladder dose in the two dimensional plan group exceeded the prescribed dose, while the three dimensional plan group was compared with the two-dimensional plan group and the two-dimensional planned group of rectal D0.1cm3, D1cm3, and D2cm3. The P values of the three groups were statistically significant in the 0.042,0.031,0.015, P0.05, and three groups, respectively. The three dimensional planned rectal D0.1cm3, D1cm3, D2cm3. The maximum, minimum, and mean values were lower than the two dimensional plan. The percentage of the rectal D0.1cm3 in the two-dimensional plan group exceeded the prescribed dose by 22.03%, while the three-dimensional plan accounted for only 8.47%. The percentage of the rectal D1cm3 super 500C Gy and the prescription dose in the two-dimensional plan group was 18.64%, 6.78%, respectively, and the three dimensional plan was 5.08%, 0%, and the rectal D2cm3 in the two-dimensional plan group was more than 5. The percentage of 00C Gy is 6.78% and the three dimensional plan is 0% (P0.05). Conclusion: 1. Radiotherapy combined with chemotherapy is effective in the treatment of cervical cancer. It can improve the total survival rate and the non progression survival rate of five years. It is better than radiotherapy and radiotherapy combined with adjuvant chemotherapy. It is an ideal treatment for cervical cancer, but it also needs to pay attention to the treatment phase caused by concurrent chemoradiotherapy. For patients who are unable to tolerate concurrent chemoradiotherapy, adjuvant chemotherapy can also gain a higher survival benefit than radiotherapy alone..2 based CT based three-dimensional intracavitary radiotherapy plan for cervical cancer can significantly increase the coverage and dose of the tumor target area, which can effectively control the high dose area. Endanger the volume of organs in the domain is beneficial to reduce the occurrence of serious complications in the treatment of close distance, especially for the middle and late patients, the larger masses, the tumor target area and the complicated relationship between the organs and other conditions. However, the development time of the three-dimensional intracavity radiotherapy is short and the experience is limited, and the experience is compared with the traditional two dimensional technology, and the experience is constantly summed up. It can improve curative effect, reduce side effects and improve the quality of life of patients.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R737.33

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