本文關(guān)鍵詞：局部晚期宮頸癌同步放化療早期療效評(píng)估的臨床應(yīng)用價(jià)值　出處：《廣西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 宮頸癌 放射治療 臨床病理因素 預(yù)后

【摘要】：研究背景:宮頸癌(cervical cancer)是婦科最常見的惡性腫瘤之一,發(fā)病人數(shù)位居所有惡性腫瘤第4位,近年來其發(fā)病率呈現(xiàn)出明顯的年輕化趨勢(shì),原位癌與浸潤癌高發(fā)年齡均有所降低。目前研究已證實(shí)宮頸癌主要與人乳頭狀瘤病毒(HPV)感染、早婚、早育、多產(chǎn)及性生活紊亂等多種因素密切相關(guān)。每年新發(fā)病人數(shù)530,000例,同時(shí)有270,000例死亡,是女性面臨的主要健康問題[1-4]。作為發(fā)展中國家癌癥死亡的主要原因,85%的宮頸癌病例發(fā)生在這些地區(qū)。一項(xiàng)針對(duì)全國29個(gè)省、市、自治區(qū)的流行病學(xué)調(diào)查報(bào)告顯示,宮頸癌死亡率高居我國所有惡性腫瘤的第四位,占女性癌癥的第二位[4]。以40歲到50歲為最多發(fā)病年齡。宮頸癌病人的治療措施中約70%以上包括放射治療,放射治療適用于所有期別的宮頸癌病人。局部晚期(ⅠB2、ⅡA2、ⅡB、ⅢB、ⅣA)宮頸癌首選同步放化療。宮頸癌放療包含體外放療(external beam radiotherapy,EBRT)與近距離放療(brachytherapy,BT)。EBRT與BT所針對(duì)的照射區(qū)域不同,前者主要是照射宮旁區(qū)域幾淋巴引流區(qū),后者則主要照射原發(fā)病灶,單獨(dú)采取某一種放療方法很難達(dá)到預(yù)期效果,只有將兩者結(jié)合起來才能達(dá)到最佳的病灶控制率。隨著技術(shù)、設(shè)備等發(fā)展,宮頸癌的放療從傳統(tǒng)的二維全面向基于CT、MRI、PET/CT的三維精確放療治療發(fā)展。傳統(tǒng)的EBRT多采用前后野或四箱野盆腔照射,優(yōu)點(diǎn)是保證了靶區(qū)內(nèi)放療劑量分布的均勻性,但缺點(diǎn)是照射野中正常組織接受的劑量與腫瘤組織是一樣多的,因此限制了靶區(qū)劑量的提高,從而影響療效。精確放療的優(yōu)點(diǎn)是提高靶區(qū)放療劑量同時(shí)最大程度的減少正常組織受照射的劑量,從而提高放療效果。傳統(tǒng)的bt是建立在二維基礎(chǔ)上的放療劑量分析,并以icru-38號(hào)報(bào)告劑量參考點(diǎn)為基礎(chǔ)進(jìn)行劑量評(píng)估。對(duì)于直徑5cm的宮頸局部腫瘤,處方劑量線無法完全包繞腫瘤靶區(qū),從而導(dǎo)致腫瘤照射劑量不足;對(duì)于直徑≤5cm的宮頸局部腫瘤,處方劑量線包括了部分周圍正常組織,導(dǎo)致副反應(yīng)的增加;同時(shí)該體系中設(shè)定的a點(diǎn)在治療中因?yàn)槟[瘤的變化及每次施源器位置的差異,會(huì)導(dǎo)致a點(diǎn)無法無重合,從而a點(diǎn)劑量不確定。因此bt也已向精確的三維近距離治療發(fā)展。臨床工作中會(huì)發(fā)現(xiàn)有些宮頸癌放療病人對(duì)射線敏感,這些敏感的病人放療預(yù)后要明顯優(yōu)于對(duì)放療部分敏感或不敏感的病人。對(duì)于放療不敏感的病人是選擇繼續(xù)放療還是手術(shù)或化療或姑息治療目前尚無標(biāo)準(zhǔn)治療方案。何時(shí)評(píng)估放療效果?采用什么標(biāo)準(zhǔn)?目前尚無定論。本研究回顧性分析放療期間有早期評(píng)估的局部晚期宮頸癌的臨床病例資料,對(duì)比不同放療效果病人的預(yù)后,探討放療期間療效評(píng)估的最佳時(shí)間、療效評(píng)估的標(biāo)準(zhǔn)及對(duì)不同放療效果病人個(gè)體化治療的策略。研究目的:探討局部晚期宮頸癌同步放化療早期療效評(píng)估的臨床應(yīng)用價(jià)值,以便為宮頸癌病人個(gè)體化治療臨床決策提供依據(jù)。研究方法:回顧性分析2011年1月-2013年11月在我院初治、符合納入標(biāo)準(zhǔn)的iib-iiib宮頸癌病人54例,所有病例均按照國際婦產(chǎn)科聯(lián)盟(figo,2009)修訂的標(biāo)準(zhǔn)進(jìn)行臨床分期,均經(jīng)宮頸活檢病理確診,除1例病人有輕度腎功能不全外,均無明顯血常規(guī)、心、肝、肺功能異常。其中iib期病人9例,iiia期病人4例,iiib期病人41例,均為宮頸鱗癌。所有病人均行三維適型調(diào)強(qiáng)放療+腔內(nèi)后裝近距離放射治療+鉑類增敏化療。所有病例均在外照射30gy行盆腔ct掃描+增強(qiáng)評(píng)估宮頸病變的大小。放化療毒副反應(yīng)予對(duì)癥處理。治療結(jié)束后進(jìn)行定期門診復(fù)查和隨訪,統(tǒng)計(jì)病人預(yù)后(pfs、os)。研究結(jié)果:在局部晚期宮頸癌病人中,figo分期可以影響局部晚期宮頸癌同步放療早期效果(P0.05),而年齡、腫瘤的大小(放療前)、腫瘤分化程度、淋巴結(jié)轉(zhuǎn)移情況等臨床病理參數(shù)與放療早期評(píng)估療效沒有顯著相關(guān)性。局部晚期宮頸癌同步放化療早期評(píng)估可能對(duì)患者的PFS有一定的指導(dǎo)意義,而對(duì)于患者的OS的意義并不大。研究結(jié)論:FIGO分期在局部晚期宮頸癌同步放療早期評(píng)估中對(duì)病人的個(gè)體化治療具有較好的臨床價(jià)值。我們?nèi)孕柽M(jìn)一步觀察,為宮頸癌的治療提供一個(gè)可行有效的方法。本課題將通過對(duì)局部晚期宮頸癌同步放化療早期評(píng)估病人進(jìn)行分組,其放化療早期評(píng)估可能對(duì)患者的PFS有一定的指導(dǎo)意義,而對(duì)于患者的OS的意義并不大,應(yīng)在早期療效評(píng)估后進(jìn)行個(gè)體化治療,最大可能的提高病人的預(yù)后和生存質(zhì)量。
[Abstract]:Background: cervical cancer (cervical cancer) is one of the most common gynecologic malignant tumor, the incidence of malignant tumors in all fourth, the incidence rate showed a significantly younger trend in recent years, carcinoma in situ and invasive cancer incidence age were decreased. The current study has confirmed that cervical cancer and human papilloma virus (HPV) infection, early marriage, early childbearing, various factors of fertility and sexual disorders are closely related. The annual incidence of 530000 cases, and 270000 cases of death, is a major health problem facing women as the main reason for the development of [1-4]. Chinese home death of cancer, 85% cervical cancer cases occur in these areas. According to a the country's 29 provinces, city, autonomous region survey report shows that cervical cancer mortality rate of all malignant tumors in China fourth, accounting for second of [4]. women's cancer at the age of 40 to 50 years of age the most The age of onset. About 70% of patients with cervical cancer treatment including radiotherapy, radiotherapy for cervical cancer patients. All other locally advanced (B2 I, II A2, B II, B III, IV A) cervical cancer preferred concurrent chemotherapy and radiotherapy for cervical cancer. External beam radiotherapy (including external radiotherapy. EBRT) and brachytherapy (brachytherapy, BT).EBRT and BT in the irradiated area is different, the former is irradiated parametrial area a few lymphatic drainage area, the latter mainly illuminated the primary focus, take a kind of radiation method is difficult to achieve the desired effect, only the combination can achieve the best the lesion control rate. With the development of technology, equipment, radiotherapy of cervical cancer from traditional two-dimensional to three-dimensional based on CT, MRI, precise radiotherapy in the treatment of PET/CT. The traditional EBRT with four boxes of wild or wild before and after pelvic irradiation, the advantages is the guarantee The dose distribution in the target area uniformity, but the disadvantage is the dose irradiation in normal tissue and tumor tissue is accepted as much, thus limiting the target dose increase, thus affecting the curative effect. The advantages of precise radiotherapy is to improve target dose and minimize the dose of normal tissue irradiated thus, to improve the effectiveness of radiotherapy. Traditional BT is based on two-dimensional analysis of radiation dose on the basis of the report and the icru-38 dose reference point as the basis for dose assessment. For the tumor diameter of 5cm, the prescription dose line cannot be completely wrapped around the tumor target, resulting in insufficient tumor dose for cervical cancer; less than 5cm, the prescription dose line includes part of the surrounding normal tissue, resulting in the increase of side effects; at the same time set in the system of a in the treatment of tumors and because of changes in each application The difference is the location of the source, can cause a to overlap, thus a point dose uncertainty. So BT has to accurate 3D brachytherapy. The clinical work will find some cervical cancer patients undergoing radiotherapy on X-ray sensitive, these sensitive radiotherapy prognosis was significantly better than that of radiotherapy on some sensitive or not sensitive the patient is not sensitive to radiotherapy. The patients choose to continue radiotherapy or surgery or chemotherapy or palliative treatment there is no standard treatment. When evaluating radiotherapy effect? What is the standard? Is unclear. This study retrospectively analyzed the early evaluation of radiotherapy for locally advanced cervical cancer clinical data and prognosis of different radiotherapy effect the patient, the best time of radiotherapy efficacy, efficacy evaluation criteria and treatment strategies of different radiotherapy individual patients. The purpose of the study is to explore Locally advanced cervical cancer radiotherapy and chemotherapy efficacy evaluation of early clinical value, so as to provide basis for clinical treatment of patients with cervical cancer. Individual decision research methods: retrospective analysis of January 2011 -2013 year in November in our hospital treatment, in accordance with the inclusion criteria of iib-iiib cervical cancer 54 cases, all cases were in accordance with the International Federation of gynecology and Obstetrics (FIGO, 2009) revised standards for clinical stage were treated by cervical biopsy, except 1 cases of patients with mild renal insufficiency, there were no obvious blood, heart, liver, lung function abnormalities. Among 9 cases of IIB patients, 4 cases of IIIA patients, 41 cases of IIIB patients were. Cervical squamous cell carcinoma. All patients underwent three-dimensional conformal intensity-modulated radiotherapy plus intracavitary brachytherapy plus platinum chemotherapy. All cases were enhanced in the radiotherapy of 30Gy underwent pelvic CT scan and evaluation of cervical lesion size. The toxicity of chemotherapy to put on Symptomatic treatment. Regular review and follow-up after the end of treatment, the statistical prognosis of patients (PFS, OS). Results: in patients with locally advanced cervical cancer, FIGO staging can affect the early effect of radiotherapy in locally advanced cervical cancer (P0.05), and age, tumor size (before radiotherapy), tumor differentiation. There was no significant correlation between lymph node metastasis and clinical pathological parameters and assess the curative effect of early radiotherapy. Concurrent chemoradiotherapy for locally advanced cervical cancer early evaluation may have certain guiding significance for patients with PFS, and for patients with OS significance. Conclusions: FIGO staging in locally advanced cervical cancer radiotherapy for early assessment of patients the individualized treatment has a good clinical value. We still need further observation, provide a feasible and effective method for the treatment of cervical cancer. This study will be based on the synchronization of locally advanced cervical cancer Put the group in early evaluation of chemotherapy patients, the chemotherapy and early evaluation may have a certain guiding significance for patients with PFS, and for patients with OS significance, should be individualized treatment in the early curative effect evaluation, prognosis and survival quality of patients increased the maximum possible.

【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.33

【參考文獻(xiàn)】

相關(guān)期刊論文 前5條

1 龔靜;張軍;;《2016年NCCN宮頸癌臨床實(shí)踐指南》解讀[J];中國全科醫(yī)學(xué);2016年27期

2 肖紹文;張珊文;;腫瘤放射治療臨床進(jìn)展[J];科技導(dǎo)報(bào);2014年26期

3 周暉;彭永排;俞進(jìn);林仲秋;;《2014年NCCN宮頸癌臨床實(shí)踐指南》解讀[J];實(shí)用婦產(chǎn)科雜志;2014年06期

4 高琨;丁麗;李力;;中晚期子宮頸癌患者調(diào)強(qiáng)放療的療效及預(yù)后影響因素分析[J];中華婦產(chǎn)科雜志;2014年01期

5 章文華;;宮頸癌篩查方法與我國宮頸癌篩查面臨的新問題[J];中華腫瘤雜志;2008年12期

，

本文編號(hào)：1389126