Department of Obstetrics and Gynecology, Lishui City People's Hospital, Lishui, China.
J BUON. 2021 Jul-Aug;26(4):1298-1305.
We aimed to evaluate the efficacy and safety of helical tomotherapy (HT) combined with computed tomography (CT)-guided three-dimensional intracavitary brachytherapy (CT-ICBT) in the treatment of locally advanced cervical cancer.
A total of 96 patients with locally advanced cervical cancer (IIB-IIIB) treated were retrospectively analyzed. They underwent concurrent radiochemotherapy, and the chemotherapy regimen paclitaxel + cisplatin was given for 3 weeks. The patients were divided into HT+CT-ICBT group (n=48) and intensity-modulated radiotherapy (IMRT) + two-dimensional ICBT (IMRT+ICBT group, n=48) according to the different extracorporeal and intracavitary radiotherapies. The short-term clinical efficacy, and short- and long-term adverse reactions were compared between the two groups, the tumor recurrence and survival status were recorded through follow-up, and the overall survival (OS) and progression-free survival (PFS) rates were compared between the two groups.
The patient general clinical characteristics were comparable in both groups. The short-term clinical effective rate was 91.7% (44/48) and 87.5% (42/48), respectively, in HT+CT-ICBT group and IMRT+ICBT group. In the two groups, the incidence rate of grade 3-4 chronic radiation proctitis was 4.2% (2/48) and 22.9% (11/48), while that of grade 3-4 chronic radiation cystitis was 2.1% (1/48) and 18.7% (9/48), respectively. According to the follow-up results, the 3-year OS was 85.4% (41/48) and 77.1% (37/48), and the 3-year PFS was 81.3% (39/48) and 70.8% (34/48), respectively, in the two groups. Log-rank test showed that the 3-year OS and PFS had no statistically significant differences (p=0.395, p=0.401).
HT+CT-ICBT is safe and effective in the treatment of locally advanced cervical cancer, and it has similar short-term clinical efficacy and long-term survival rate compared with IMRT+ICBT, which also significantly reduces the long-term incidence of radiation proctitis and cystitis, so it is worthy of popularization and application.
评估螺旋断层放疗（HT）联合 CT 引导三维腔内近距离放疗（CT-ICBT）治疗局部晚期宫颈癌的疗效和安全性。
回顾性分析 96 例局部晚期宫颈癌（IIB-IIIB 期）患者，均行同期放化疗，化疗方案为紫杉醇+顺铂，3 周为 1 个周期。根据体外和腔内放疗方式的不同，将患者分为 HT+CT-ICBT 组（n=48）和调强放疗（IMRT）+二维腔内近距离放疗（IMRT+ICBT 组，n=48）。比较两组患者的近期临床疗效、近期和远期不良反应，随访记录肿瘤复发和生存情况，比较两组患者的总生存（OS）和无进展生存（PFS）率。
两组患者的一般临床特征比较，差异无统计学意义（P>0.05）。HT+CT-ICBT 组和 IMRT+ICBT 组近期临床有效率分别为 91.7%（44/48）和 87.5%（42/48）。两组患者 3 级及以上慢性放射性直肠炎发生率分别为 4.2%（2/48）和 22.9%（11/48），3 级及以上慢性放射性膀胱炎发生率分别为 2.1%（1/48）和 18.7%（9/48）。随访结果显示，两组患者 3 年 OS 率分别为 85.4%（41/48）和 77.1%（37/48），3 年 PFS 率分别为 81.3%（39/48）和 70.8%（34/48）。Log-rank 检验结果显示，两组患者 3 年 OS 和 PFS 差异均无统计学意义（P=0.395，P=0.401）。
HT+CT-ICBT 治疗局部晚期宫颈癌安全有效，与 IMRT+ICBT 相比，近期临床疗效及远期生存率相当，且能显著降低放射性直肠炎和膀胱炎的长期发生率，值得推广应用。
