Ke Gui-Hao, Huang Xiao, Huang Xiao-Wei, Liu Su-Ping, Wu Xiao-Hua
Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China. Email:
Zhonghua Fu Chan Ke Za Zhi. 2013 Sep;48(9):649-53.
To investigate the treatment effects and toxicities of extended-field intensity modulated radiation therapy (EF-IMRT) and intra-cavitary brachytherapy combined with chemotherapy for stageIb1-IVa cervical cancer with positive para-aortic lymph nodes.
A total of 46 stage Ib1-IVa cervical cancer patients with positive para-aortic lymph nodes treated at Fudan University Shanghai Cancer Center between 2009 and 2011 were reviewed. Neoadjuvant, concomitant and adjuvant chemotherapy with paclitaxel and carboplatin were administrated for one cycle before radiation therapy, two cycles during radiation therapy or three cycles after radiation therapy. All patients received EF-IMRT and intra-cavitary brachytherapy. The positive lymph nodes received an additional boost dose.
All patients received EF-IMRT to 50.4 Gy (1.8 Gy per fraction). Twenty-six patients was treated with boost dose of 6.0-8.0 Gy in 2.0 Gy per fraction to positive para-aortic lymph nodes. Thirty-seven patients received a positive para-aortic lymph nodes boost or (and) parametrial boost. All patient also received a high-dose-rate intra-cavitary brachytherapy at the point "A" dose of 20.0-30.0 Gy in 5.0 Gy per fraction. Total chemotherapy cycles were 189, and the average patient received 4.1 courses. Two cases (4%, 2/46) experienced grade III gastrointestinal toxicities, no patients suffered grade IV gastrointestinal toxicities. Fifteen cases (33%, 15/46) experienced grade III hematological toxicities, and 3(7%, 3/46) experienced grade IV hematological toxicities.Late grade III-IV toxicity was seen in 3 cases (7%, 3/46). The 3 year progression- free survival rate was 46.2%, and the 3 years overall survival rate was 61.2%.
EF-IMRT and intra-cavitary brachytherapy combined with chemotherapy is safe and effective for stageIb1-IVa cervical cancer with positive para-aortic lymph nodes.
探讨扩大野调强放射治疗（EF-IMRT）联合腔内近距离放疗及化疗对伴有主动脉旁淋巴结转移的Ib1-IVa期宫颈癌的治疗效果及毒性反应。
回顾性分析2009年至2011年在复旦大学附属肿瘤医院接受治疗的46例伴有主动脉旁淋巴结转移的Ib1-IVa期宫颈癌患者。在放疗前给予1周期新辅助化疗、放疗期间给予2周期同步化疗或放疗后给予3周期辅助化疗，化疗方案为紫杉醇联合卡铂。所有患者均接受EF-IMRT和腔内近距离放疗，对阳性淋巴结给予追加剂量照射。
所有患者接受EF-IMRT剂量为50.4 Gy（每次分割剂量1.8 Gy）。26例患者对阳性主动脉旁淋巴结给予6.0-8.0 Gy（每次分割剂量2.0 Gy）的追加剂量照射。37例患者接受了阳性主动脉旁淋巴结或（和）宫旁组织的追加照射。所有患者均接受了高剂量率腔内近距离放疗，A点剂量为20.0-30.0 Gy（每次分割剂量5.0 Gy）。化疗总周期数为189个，平均每位患者接受4.1个疗程。2例（4%，2/46）出现III级胃肠道毒性反应，无患者出现IV级胃肠道毒性反应。15例（33%，15/46）出现III级血液学毒性反应，3例（7%，3/46）出现IV级血液学毒性反应。3例（7%，3/46）出现晚期III-IV级毒性反应。3年无进展生存率为46.2%，3年总生存率为61.2%。
EF-IMRT联合腔内近距离放疗及化疗治疗伴有主动脉旁淋巴结转移的Ib1-IVa期宫颈癌安全有效。
