宫颈癌盆腔放疗中央全挡铅与半挡铅结合锎-252中-第三军医大学学报.DOC

锎-252中子结合治疗宫颈癌挡铅与半挡铅的观察[摘要] 目的 比较锎-252中子结合治疗宫颈癌挡铅与半挡铅的。方法选取20024～36 Gy后，全挡组盆腔野中央挡铅4 cm，而半挡组为盆腔野中央骶3以下部分挡铅4cm，继续照射至48～54Gy。中子内照射宫旁A点总剂量40-42Gy，1次/周，10-12Gy /次，共进行4次。全盆外照及锎-252腔内照射结束后,对宫旁仍有侵犯的Ⅲb期病人,宫旁小野补量8-12Gy。用McNemar test的方法比较严重急性期并发症（≥G2）发生率和总体生存率、绝对无病生存率、局部控制率及严重晚期并发症（放射性直肠炎和膀胱炎）（≥G2）发生率的差异。平均随访期42个月。结果 全挡组和半挡组病人急性期胃肠道反应的发生率分别为16％和18％(p=0.642)，放射性直肠炎发生率分别为23.5％和25.2％(p=0.759)，放射性膀胱炎发生率分别为5.2％和6.1％(p=0.775)。全挡组和半挡组病人的总体生存率分别为73.0%和78.3%（p= 0.357），绝对无病生存率分别为73.0%和76.5 %（p= 0.544），局部控制率分别为 80.0%和 84.3%（p= 0.389），盆腔淋巴结复发率分别为5.2％和3.5％（p=0.652），晚期并发症发生率分别为13.0%和12.2%（p=0.843）。两组患者的急性期并发症、总体生存率、绝对无病生存率、局控率、盆腔淋巴结复发率和晚期并发症的发生率均无明显差异。结论 半挡组的总体生存率、绝对无病生存率、局控率略高于全挡组，且盆腔淋巴结复发率和晚期并发症的发生率略低于全挡组，所以我们建议宫颈癌病人根治性放疗盆腔外照射时尽可能采取半挡铅照射技术。 [关键词] 宫颈癌锎-252 雷新, dpleixin@163.com Californium (Cf)-252 neutron intracavitary brachytherapy combined with external beam radiotherapy for the treatment of cervical cancer: pairwise comparison between long term outcome of whole lead block and partial lead block of the pelvic fields during whole pelvic field irradiation HuaPing Gao, Xin Lei Ph.D, Cheng Tang, Jia Liu, Cancer Center, institute of Surgery Research, Daping Hospital , Third Military Medical University ABSTRACT Objective: The aim of the study was to compare the results of whole lead block and partial lead block of the pelvic fields during the combination external beam radiotherapy (EBRT) and 252Cf neutron intracavitary brachytherapy (ICBT) for cervical cancer. Methods: From March 2007 to October 2008 and May 2009 to December 2009, 115 patients who had been diagnosed with stage IIA-IIIB cervical squamous carcinoma by biopsy were enrolled and paired according to clinical stage, age, tumor size, and degree of anemia. They were divided into whole lead block (WLB) and partial lead block (PLB) groups during pelvic field radiation. For 252Cf ICBT, the total to Point A was 40-42Gy, 9-11 Gy/f/w×4f. As for whole pelvis EBRT, anteroposterior (A-P) and posteroanterior (P-A) opposed fields were imple