调强放疗联合三维后装腔内放疗治疗中晚期宫颈癌患者效果及对并发症影响被引量：24

Clinical Efficacy of Intensity Modulated Radiotherapy Combined with Three-dimensional Afterloading Intracavitary Radiotherapy in Treatment of Patients with Moderate-advanced Cervical Cancer and Its Effect on Complications

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摘要目的探讨调强放疗联合三维后装腔内放疗治疗中晚期宫颈癌患者效果及对并发症影响。方法选取2018年3月—2019年3月收治的中晚期宫颈癌78例,根据放疗方案不同将其分为A组和B组两组各39例。A组予调强放疗联合三维后装腔内放疗,B组予四野盒式三维适形放疗联合三维后装腔内放疗。比较两组疗程结束后临床效果、危险器官受照体积和并发症发生情况,治疗前和疗程结束后外周血T淋巴细胞亚群和血清人附睾蛋白4、胸苷激酶1、血管内皮生长因子水平,以及随访24个月生存情况。结果两组疗程结束后总有效率和随访6、12、24个月时生存率比较差异无统计学意义(P>0.05)。疗程结束后,股骨头、骨髓、膀胱、直肠受照体积和总并发症发生率A组小于或低于B组(P<0.05或P<0.01)。疗程结束后,两组CD3+、CD4+、CD4+/CD8+和血清人附睾蛋白4、胸苷激酶1、血管内皮生长因子低于治疗前,CD8+高于治疗前;A组CD3+、CD4+和CD4+/CD8+高于B组,CD8+和血清人附睾蛋白4、胸苷激酶1、血管内皮生长因子低于B组(P<0.05或P<0.01)。结论调强放疗联合三维后装腔内放疗治疗中晚期宫颈癌可缩小危险器官受照体积,减少对免疫功能影响,降低血清人附睾蛋白4、胸苷激酶1和血管内皮生长因子水平,且并发症少。 Objective To investigate clinical efficacy of intensity modulated radiotherapy(IMRT)combined with three-dimensional afterloading intracavity radiotherapy in treatment of patients with moderate-advanced cervical cancer and its effect on complications.Methods A total of 78 patients with moderate-advanced cervical cancer admitted between March 2018 and March 2019 were selected and divided into group A(n=39)and group B(n=39)according to different radiotherapy schemes.Group A received IMRT combined with three-dimensional afterloading intracavity radiotherapy,while group B received three-dimensional conformal radiotherapy using four filed box combined with three-dimensional afterloading intracavity radiotherapy.The therapeutic efficacy,irradiation volumes of organs at risk(OAR),incidence rate of complications after treatment,levels of peripheral blood T lymphocyte subsets,serum human epididymal protein 4,thymidine kinase 1 and vascular endothelial growth factor(VEGF)before and after treatment as well as survival conditions with follow-up for 24-month were compared between two groups.Results There were no significant differences in the total effective rate after treatment and survival rates with follow-up for 6,12 and 24 months between two groups(P>0.05).The irradiation volumes of femoral head,bone marrow,bladder and rectum and the incidence rate of total complications in group A were less or lower than those in group B(P<0.05 or P<0.01).After treatment,levels of CD3+,CD4+,CD4+/CD8+,serum human epididymal protein 4,thymidine kinase 1 and VEGF were significantly lower,while CD8+levels were significantly higher than those before treatment in two groups;in group A,levels of CD3+,CD4+and CD4+/CD8+were significantly higher,while CD8+and serum human epididymal protein 4,thymidine kinase 1 and VEGF were significantly lower than those in group B(P<0.05 or P<0.01).Conclusion IMRT combined with three-dimensional afterloading intracavitary radiotherapy in treatment of patients with moderate-advanced cervical cancer may reduce the irradiation volume of OAR and effect on immune function and decrease levels of serum human epididymal protein 4,thymidine kinase 1 and VEGF with fewer complications.

作者杨红霞王静许新明高灵灵张坤刘琦杨健 YANG Hong-xia;WANG Jing;XU Xin-ming;GAO Ling-ling;ZHANG Kun;LIU Qi;YANG Jian(Department of Radiotherapy,Cangzhou People's Hospital,Cangzhou,Hebei 061000,China)

机构地区沧州市人民医院放疗科

出处《临床误诊误治》 CAS 2021年第11期55-59,共5页 Clinical Misdiagnosis & Mistherapy

基金河北省科技计划项目(152777186)。

关键词宫颈肿瘤调强放疗三维适形放疗腔内放射并发症 T淋巴细胞人附睾蛋白4 胸苷激酶1 血管内皮生长因子 Uterine cervical neoplasms Intensity-modulated radiotherapy Three-dimensional conformal radiotherapy Intracavitary radiation Complications T-lymphocytes Human epididymis protein 4 Thymidine kinase 1 Vascular endothelial growth factor