栾朝辉 田春香 刘淑美 王志美

[摘要] 目的 探讨宫颈癌腹膜后淋巴结转移的调强适形放疗的临床疗效。方法 整群选取于2012年1月—2013年3月该院妇科收治的78例宫颈癌腹膜后淋巴结转移患者为研究对象。根据患者及家属意愿选择放疗方式，其中40例接受常规放疗的患者为对照组，接受调强适形放疗的38例患者为研究组对象。对照组患者采用常规放疗法，研究组患者采用调强适形放疗法，两组患者均在放疗后接受紫杉醇+铂类的全身化疗，化疗时间为3～6个治疗周期。治疗结束后于0.6～3年内进行随访，比较两组患者的临床疗效以及放疗后不良反应的发生情况。 结果 治疗结束后于0.6～3年内进行随访，随访率为100%。对照组，总治疗有效率为35.0%。研究组总治疗有效率为79.0%。与对照组相比，研究组患者的治疗有效率显著较高，P<0.05。对照组总不良反应发生率为85.0%；研究组总不良反应发生率为28.9%。与对照组相比，研究组不良反应发生率明显降低，P<0.05。结论 应用调强适形放疗能够进一步提高肿瘤内剂量，降低正常组织的剂量，提高疗效，降低并发症，值得临床推广应用。

[关键词] 宫颈癌；腹膜；淋巴结；调强适形放疗

[中图分类号] R733 [文献标识码] A [文章编号] 1674-0742（2015）08（c）-0073-03

Clinical Efficacy of Intensity Modulated Radiotherapy in Treatment of Retroperitoneal Lymph Node Metastasis in Patients with Cervical Cancer

LUAN Zhao-hui1， TIAN Chun-xiang2， LIU Shu-mei1， WANG Zhi-mei1

1.Department of Gynecologic Oncology， Tumor Hospital of Shandong Province， Qingdao， Shandong Province， 266042 China；2. Department of Radiation Physics， Tumor Hospital of Shandong Province， Qingdao， Shandong Province， 266042 China

[Abstract] Objective To discuss the clinical effect of intensity modulated radiotherapy in the treatment of cervical cancer patients with retroperitoneal lymph node metastasis. Methods 78 cervical cancer patients with retroperitoneal lymph node metastasis admitted to the Department of Gynecologic Oncology of our hospital were selected as the research group and divided， according to radiation methods chosen by patients and their family members， into control group in which the 40 patients underwent conventional radiotherapy， and study group in which the 38 patients were given intensity modulated radiotherapy. After radiotherapy， all the patients were given 3-6 treatment cycles of combined systemic chemotherapy of paclitaxel and platinum and 0.6-3 years follow-up. We compared the clinical effects and adverse reactions between the two groups. Results All the patients experienced a 0.6-3 years follow-up after treatment， which showed that the total effective rate was higher and the adverse reaction rate lower in the study group than in the control group with statistically significant differences， respectively 79.0% vs 35.0% and 28.9% vs 85.0%， P<0.05. Conclusion Intensity modulated radiotherapy， in the treatment of cervical cancer patients with retroperitoneal lymph node metastasis， has dosimetric advantage which can improve the treatment effect and reduce adverse reaction， therefore it is worthy of promotion in clinical practice.

[Key words] Cervical cancer； Peritoneum； Lymph node； Intensity modulated radiotherapy

对于早期浸润性宫颈癌主要是采用放射性治疗，然而，放疗后仍有患者会出现腹膜后淋巴结的转移，且有研究表明，患者的临床分期级别越高，出现腹膜后淋巴结转移的概率越大[1-3]。患者出现淋巴结转移后，会使得治疗更加困难，全身化疗以及放疗的结果均不理想，使得无法进行连续治疗，从而导致治疗失败。因此，调强适形放疗作为一种可以保持照射野的形状与靶区的形状一致的技术，已在治疗外形不规则肿瘤上得到一定的临床应用[4]。该研究整群选取于2012年1月—2013年3月该院收治的78例宫颈癌腹膜后淋巴结转移患者为研究对象，探讨了调强适形放疗治疗宫颈癌腹膜后淋巴结转移的临床疗效，现报道如下。……