本文選題：宮頸癌 + 同步放化療��； 參考：《安徽醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的通過比較同步放化療與同步放化療聯(lián)合重組人p53腺病毒注射液在中晚期宮頸癌治療前后的影像學(xué)表現(xiàn)及DNA倍體定量分析結(jié)果,評價(jià)同步放化療聯(lián)合重組人p53腺病毒注射液治療中晚期宮頸癌的近期臨床療效。方法將符合入組條件的142例初治的中晚期宮頸癌患者隨機(jī)分為治療組(同步放化療聯(lián)合重組人p53基因治療)42例和對照組(同步放化療)100例。治療組患者于放療前72小時(shí)行重組人p53腺病毒注射液瘤內(nèi)注射一次,此后每周行瘤內(nèi)注射一次,連續(xù)2~4次。兩組患者均采用三維適形調(diào)強(qiáng)放療(IMRT)的體外照射方式配合銥-192腔內(nèi)治療,且放療劑量及放療方式相同;同時(shí)兩組患者于放療開始第一周的周六或周日行“順鉑40mg/m2”同步化療,連續(xù)6周。治療結(jié)束2月后,復(fù)查盆腔增強(qiáng)MRI,通過測量腫瘤最大截面積(腫瘤最長直徑×垂直徑的最大寬度),以此觀察患者腫瘤大小變化及評估治療療效;并分別于治療前、后采用婦科宮頸脫落細(xì)胞采集刷刷取宮頸細(xì)胞,行DNA倍體定量分析,依據(jù)兩組患者治療前、后宮頸細(xì)胞DNA指數(shù)(DNA index,DI)≥2.5細(xì)胞個(gè)數(shù)的變化評估近期臨床治療療效。結(jié)果治療結(jié)束2月后,復(fù)查盆腔增強(qiáng)MRI,結(jié)果示治療組患者治療前、后與對照組相比,瘤體消退較為理想。治療組42例病人,CR 26例(61.9%);PR 12例(28.6%);有效率90.5%;對照組100例病人,CR 28例(28%);PR 36例(36%);有效率64%;其中治療組有效率明顯高于對照組(90.5%VS 64.0%;P0.05),有統(tǒng)計(jì)學(xué)意義。DNA倍體定量分析結(jié)果示治療前治療組與對照組差異無統(tǒng)計(jì)學(xué)意義(χ~2=0.953,P=0.329)。治療結(jié)束后治療組與對照組差異具有統(tǒng)計(jì)學(xué)意義(χ~2=6.558,P=0.01)。結(jié)論影像學(xué)及DNA倍體定量分析結(jié)論一致,提示重組人p53腺病毒聯(lián)合同步放化療治療中晚期宮頸癌近期療效優(yōu)于同步放化療組。
[Abstract]:Objective to compare the imaging findings and quantitative analysis of DNA ploidy between simultaneous radiotherapy and chemotherapy combined with recombinant human p53 adenovirus injection before and after treatment for advanced cervical cancer. To evaluate the clinical efficacy of concurrent radiotherapy and chemotherapy combined with recombinant human p53 adenovirus injection in the treatment of advanced cervical cancer. Methods 142 newly treated patients with advanced cervical cancer were randomly divided into treatment group (n = 42) and control group (n = 100). Patients in the treatment group were injected with recombinant human p53 adenovirus injection 72 hours before radiotherapy. The patients in both groups were treated with three dimensional conformal intensity modulated radiotherapy (IMRT) in vitro combined with intracavitary iridium 192, and the same dose of radiotherapy and radiotherapy were used in both groups. Meanwhile, the patients in both groups received "cisplatin 40mg/m2" concurrent chemotherapy on Saturday or Sunday of the first week of radiotherapy. Six weeks in a row. After 2 months of treatment, the pelvic enhanced MRI was re-examined to observe the tumor size and evaluate the therapeutic efficacy by measuring the tumor maximum cross-sectional area (the longest diameter of tumor 脳 the largest width of the vertical diameter). Then the cervical cells were collected and brushed by exfoliated cells of gynecological cervix, and the quantitative analysis of DNA ploidy was performed. According to the changes of DNA index of cervical cells (DNA index) 鈮，

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