调强适形放疗联合化疗治疗复发性上皮性卵巢癌20例临床分析

发布时间：2018-07-12 10:43

本文选题：复发性上皮性卵巢癌 + 调强适形放疗　；参考：《山西医科大学》2016年硕士论文

【摘要】：目的:观察调强适形放疗联合化疗治疗复发性上皮性卵巢癌的临床疗效及不良反应。方法:回顾性分析2010年1月至2015年1月山西省肿瘤医院收治的复发性上皮性卵巢癌患者40例,其中单纯化疗20例(对照组),调强适形放疗联合化疗20例(实验组)。对照组患者应用多西他赛30mg/m2静脉滴注第1、8、15、22、29、36天,根据患者既往使用铂类药物情况,可选择卡铂(AUC=5-6)或顺铂70mg/m2或洛铂30mg/m2或奥沙利铂130mg/m2静脉滴注第1、22天,每8周重复1次,化疗2-3个疗程;实验组患者应用6MV-X线调强适形放疗同步化疗(化疗药物用法及剂量同对照组),计划靶区的处方剂量为41-63Gy,中位剂量为53.5Gy,1.8-2.0Gy/次/日,5次/周。化疗2-3个疗程后,评价患者的治疗效果、不良反应情况。结果:对照组完全缓解1例(5%),部分缓解2例(10%),稳定5例(25%),进展12例(60%),有效率为40%;实验组完全缓解7例(35%),部分缓解4例(20%),稳定4例(20%),进展5例(25%),有效率为75%。两组之间有效率比较差异显著,有统计学意义(c2=5.01,p0.05)。中位生存期对照组为7.8个月,实验组为19.3个月,两组比较有显著性差异,有统计学意义(c2=3.869,p0.05)。对照组发生白细胞减少13例,占65%,其中I-II度11例,占50%,III-IV度3例,占15%;血红蛋白与血小板下降程度较轻,主要为I-II度,分别为13例(65.5%)、4例(20%)。实验组发生白细胞减少14例,占70%,其中I-1I度9例,占45%,III-IV度5例,占25%;血红蛋白与血小板下降程度亦较轻,主要为I-II度,分别为11例(60%)、5例(25%)。两组患者骨髓抑制发生率比较无显著性差异(c2=0.50,p0.05)。对照组发生消化道反应(恶心、呕吐)3例,占15%,实验组发生消化道反应(恶心、呕吐)4例,占20%,两组胃肠道反应发生率比较无统计学差异(c2=0.17,p0.05);对照组发生肝功能异常2例,占10%,实验组发生肝功能异常3例,占15%,两组肝功能异常发生率比较无统计学差异(c2=0.23,p0.05);对照组发生肾功能异常1例,占5%,实验组发生肾功能异常2例,占10%,两组肾功能异常发生率比较无统计学差异(c2=0.37,p0.05)。结论:调强适形放疗联合化疗在治疗阴道残端、腹盆腔及淋巴结等部位复发的上皮性卵巢癌患者方面,近期疗效比单纯化疗好,总生存期明显延长,且不良反应(骨髓抑制、胃肠道反应等)未明显加重,可以作为此类患者的综合治疗方法之一。
[Abstract]:Objective: to observe the clinical efficacy and adverse reactions of intensity modulated conformal radiotherapy combined with chemotherapy in the treatment of recurrent epithelial ovarian cancer. Methods: from January 2010 to January 2015, 40 patients with recurrent epithelial ovarian cancer treated in Shanxi Cancer Hospital were retrospectively analyzed, including 20 cases of simple chemotherapy (control group) and 20 cases of intensity modulated conformal radiotherapy combined with chemotherapy (experimental group). Patients in the control group were given docetaxel 30mg/m2 intravenously for 36 days. According to the past use of platinum drugs, carboplatin (AUC5-6) or cisplatin 70mg/m2 or 30mg/m2 or oxaliplatin 130mg/m2 were given intravenously for 22 days and repeated every 8 weeks. The patients in the experimental group were treated with 6MV-X intensity modulated intensity conformal radiotherapy (chemotherapy drug usage and dose were the same as the control group). The prescribed dose of the planned target area was 41-63 Gy, and the median dose was 53.5 Gy 1.8-2.0 Gy per day per week. After 2-3 courses of chemotherapy, the therapeutic effects and adverse reactions of the patients were evaluated. Results: in the control group, 1 case (5%) was completely relieved, 2 cases (10%) were partially relieved, 5 cases (25%) were stable, 12 cases (60%) were progressive, and the effective rate was 40%, in the experimental group, there were 7 cases (35%) of complete remission, 4 cases (20%) of partial remission, 4 cases (20%) of stability, 5 cases (25%) of progress, and the effective rate was 75%. There was a significant difference in the effective rate between the two groups (c2 + 5.01, p0.05). The median survival time was 7.8 months in the control group and 19.3 months in the experimental group. In the control group, there were 13 cases of leukopenia (65%), 11 cases of I-II grade, 3 cases of III-IV degree (15%), and 13 cases (65.5%) of hemoglobin and thrombocytopenia, 4 cases (20%) of hemoglobin and thrombocytopenia. There were 14 cases of leukopenia in the experimental group (9 cases of I-1I degree, 5 cases of grade 455III-IV), and mild degree of hemoglobin and thrombocytopenia, mainly I-II degree (11 cases (60%), 5 cases (25%). There was no significant difference in the incidence of bone marrow suppression between the two groups (c 2 0. 50 p 0.05). Gastrointestinal reaction (nausea and vomiting) occurred in 3 cases (15%) in the control group, 4 cases (20 cases) in the experimental group (nausea and vomiting). There was no significant difference in the incidence of gastrointestinal reaction between the two groups (c20.17p0.05), and hepatic dysfunction in 2 cases in the control group. There were 3 cases of abnormal liver function in the experimental group (15 cases). There was no significant difference in the incidence of abnormal liver function between the two groups (c20.23 p0.05), 1 case (5%) in the control group and 2 cases in the experimental group. There was no significant difference in the incidence of abnormal renal function between the two groups (c2P = 0.37, p 0.05). Conclusion: Intensity-modulated radiotherapy combined with chemotherapy in the treatment of recurrent epithelial ovarian cancer patients with vaginal stump, abdominal and pelvic cavity and lymph nodes, the short-term effect is better than that of chemotherapy alone, the total survival time is significantly longer, and the adverse reaction (bone marrow suppression). Gastrointestinal reaction, etc.) not significantly aggravated, can be used as a comprehensive treatment of such patients.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R737.31

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