本文選題：宮頸癌 + 同步放化療　； 參考：《蘇州大學》2015年碩士論文

【摘要】：目的:1、觀察和分析宮頸癌患者單純放療、同步放化療、輔助化療的臨床治療效果以及治療相關副作用,以評估不同的治療方案在臨床應用中的價值。2、鑒于傳統(tǒng)二維后裝放療無法個體化評估不同宮頸癌患者腫瘤和危及器官受照射的劑量體積,采用CT引導的三維適形近距離放射治療技術治療中晚期宮頸癌患者,通過比較和分析不同的近距離放療技術治療宮頸癌患者腫瘤和危及器官的劑量體積,評價在CT引導下的近距離放療在宮頸癌放療中的應用優(yōu)勢和不足,為臨床應用和推廣該技術提供依據(jù)。方法:第一部分選取127例2008年10月至2013年10月于我科行治療的宮頸癌病人,根據(jù)治療方案分為三組,單純放療組45例,放療聯(lián)合順鉑周化療組58例,放療聯(lián)合輔助化療組24例,三組均行根治性放療,同步放化療組予放療同期每周順鉑化療,輔助化療組予根治性放療后紫杉醇+卡鉑化療,比較三組病人的生存率和副作用發(fā)生率的差異。第二部分選擇2014年2月至2014年12月期間在蘇州大學附屬第一醫(yī)院放療科行根治性放療的12例中晚期宮頸癌患者為研究對象,采用Phillip 16排螺旋CT模擬機掃描定位,共采集圖像59次,根據(jù)GEC-ESTRO推薦勾畫靶區(qū)和危險器官,在Oncentra治療計劃系統(tǒng)上用同樣的施源器分別設計二維、三維的治療計劃,比較兩種計劃的劑量參數(shù)。結果:第一部分 全組病人均順利完成治療,中位隨訪時間41個月,單純放療組獲CR24例,PR14 II例,SD4例,PD3例,CR為53.33%;順鉑周化療組獲CR45例,PR8例,SD3例,PD2例,CR為77.59%;輔助化療組獲CR15例,PR6例,SD2例,PD1例,CR為62.50%。三組CR差異有統(tǒng)計學意義(P=0.4960.05)。單純放療組、順鉑周化療組、輔助化療組的兩年總生存率分別為66.2%、85.4%、74.9%,三年總生存率分別為:64.2%、82.4%、74.9%,五年總生存率分別為:54.8%、78.1%、74.9%,兩年無進展生存率分別為:57.9%、85.4%、69.3%,三年無進展生存率分別為:56.1%、82.4%、69.3%,差異均具有統(tǒng)計學意義(P0.05)。三組不良反應主要以1-2級為主,其中白細胞、血小板減少、惡心嘔吐、膀胱損傷發(fā)生具有統(tǒng)計學差異,三級以上放射性直腸損傷發(fā)生率為7.09%,三級以上放射性膀胱損傷發(fā)生率為0.79%,一旦發(fā)生,嚴重降低患者的生活質(zhì)量。第二部分三維計劃的高危CTV D90最小值、最大值、平均值及中位數(shù)明顯高于二維計劃的D90,三維計劃高危CTV D90平均值為(528.06±70.29)c Gy,二維計劃高危CTV D90平均值為(425.66±95.94)c Gy。兩種計劃的D90差異具有統(tǒng)計學意義(P=0.000)。三維計劃組與二維計劃組膀胱D0.1cm3、D1cm3、D2cm3相比,P值分別為0.824、0.885、0.899,差異均無統(tǒng)計學意義,但三維計劃的膀胱D0.1cm3、D1cm3、D2cm3的最大值、最小值、平均值均低于二維計劃。在D0.1cm3對比中,二維計劃組有11.86%的膀胱劑量超過處方劑量600c Gy,而三維計劃組比例為10.17%;在D1cm3對比中,二維計劃組有1.69%的膀胱劑量超過處方劑量,而三維計劃組為0%。三維計劃組與二維計劃組直腸D0.1cm3、D1cm3、D2cm3相比,三組的P值分別為0.042、0.031、0.015,P0.05,三組差異均有統(tǒng)計學意義。三維計劃的直腸D0.1cm3、D1cm3、D2cm3的最大值、最小值及平均值均低于二維計劃。二維計劃組直腸D0.1cm3超過處方劑量的百分比為22.03%,而三維計劃僅占8.47%;二維計劃組直腸D1cm3超500c Gy和處方劑量的百分比分別為18.64%、6.78%,而三維計劃分別占5.08%、0%;二維計劃組直腸D2cm3超過500c Gy的百分比為6.78%,而三維計劃為0%(P0.05)。結論:1、放療同步聯(lián)合化療治療宮頸癌療效顯著,可提高五年總生存率和無進展生存率,優(yōu)于單純放療和放療聯(lián)合輔助化療,是理想的宮頸癌治療方法,但也需要注意因同步放化療引起的治療相關毒性反應的增加。對于不能耐受同步放化療的病人,輔助化療也能取得較單純放療更高的生存獲益。2、以CT影像為基礎的宮頸癌三維腔內(nèi)放療計劃與常規(guī)二維計劃相比,能夠顯著增加腫瘤靶區(qū)包繞及受照劑量,可以有效控制高劑量區(qū)域內(nèi)危及器官的體積,有利于降低近距離治療嚴重并發(fā)癥的發(fā)生,尤其對于中晚期病人,腫塊較大,腫瘤靶區(qū)與危及器官關系復雜等情況時優(yōu)勢更明顯。但三維腔內(nèi)放療發(fā)展時間較短,經(jīng)驗有限,需要和傳統(tǒng)二維技術相比較,不斷總結經(jīng)驗,提高療效,降低副反應,提高患者的生活質(zhì)量。
[Abstract]:Objective: 1, to observe and analyze the clinical efficacy and side effects of radiotherapy, concurrent chemoradiotherapy, adjuvant chemotherapy and treatment for cervical cancer patients, in order to evaluate the value of different treatments in the clinical application of.2. Volume volume, CT guided three-dimensional conformal near range radiation therapy for patients with advanced cervical cancer, by comparing and analyzing the different dose of near range radiotherapy for cancer patients and endanger organs, evaluate the advantages and disadvantages of the application of CT guided radiation therapy in the radiotherapy of cervical cancer. The first part selected 127 cases of cervical cancer treated by our department from October 2008 to October 2013. According to the treatment scheme, the patients were divided into three groups, 45 cases were treated with radiotherapy alone, 58 cases with radiotherapy combined with cisplatin chemotherapy group, 24 cases with radiotherapy combined with adjuvant chemotherapy group, and all the three groups were treated with radical radiotherapy and synchronous radiotherapy and chemotherapy group. Radiotherapy was treated with cisplatin chemotherapy for the same period, and adjuvant chemotherapy group was treated with paclitaxel plus carboplatin chemotherapy after radical radiotherapy. The difference of survival rate and side effect rate between the three groups was compared. The second part selected 12 cases of middle and advanced cervical cancer patients in the Radiotherapy Department of First Hospital Affiliated to Suzhou University from February 2014 to December 2014. The study object, using the Phillip 16 row spiral CT simulation machine scanning location, collects the image 59 times, according to the GEC-ESTRO recommends the target area and the dangerous organ, in the Oncentra treatment plan system, uses the same application source to design the two dimensional, three-dimensional treatment plan respectively, and compares the two kinds of planning dose parameters. After 41 months of follow-up, the median follow-up period was 41 months, the radiotherapy group received CR24, PR14 II, SD4, PD3, and CR 53.33%, and cisplatin week chemotherapy group received CR45, PR8, SD3, PD2, CR 77.59%. The total survival rate of the chemotherapy group was 66.2%, 85.4%, 74.9%, and the total survival rate of three years were 64.2%, 82.4%, 74.9% and five years respectively: 54.8%, 78.1%, 74.9%, respectively: 57.9%, 85.4%, 69.3%, respectively, respectively. (P0.05). Three groups of adverse reactions were mainly grade 1-2, of which white blood cells, thrombocytopenia, nausea and vomiting, bladder injury were statistically different, the incidence of radioactive rectal injury above three levels was 7.09%, and the incidence of radioactive bladder injury above three levels was 0.79%. Once it occurred, the quality of life of the patients was severely reduced. Second parts three were severely reduced. The minimum value, maximum value, average value and median of the high risk CTV D90 were significantly higher than the D90 of the two dimensional plan. The average value of the high risk CTV D90 of the three dimensional plan was (528.06 + 70.29) C Gy, the average value of the high risk CTV of the two dimensional plan was (425.66 + 95.94) C Gy., and the D90 difference of the two plans was statistically significant. The P values of the bladder D0.1cm3, D1cm3, and D2cm3 were 0.824,0.885,0.899, respectively, and the difference was not statistically significant, but the maximum, minimum, and average value of the bladder D0.1cm3, D1cm3, D2cm3 in the three dimensional plan were lower than the two dimensional plan. In the D0.1cm3 contrast, 11.86% of the two dimensional plan group had a bladder dose exceeding the prescribed dose 600C Gy, and the ratio of the three dimensional plan group. For 10.17%, in the D1cm3 contrast, 1.69% of the bladder dose in the two dimensional plan group exceeded the prescribed dose, while the three dimensional plan group was compared with the two-dimensional plan group and the two-dimensional planned group of rectal D0.1cm3, D1cm3, and D2cm3. The P values of the three groups were statistically significant in the 0.042,0.031,0.015, P0.05, and three groups, respectively. The three dimensional planned rectal D0.1cm3, D1cm3, D2cm3. The maximum, minimum, and mean values were lower than the two dimensional plan. The percentage of the rectal D0.1cm3 in the two-dimensional plan group exceeded the prescribed dose by 22.03%, while the three-dimensional plan accounted for only 8.47%. The percentage of the rectal D1cm3 super 500C Gy and the prescription dose in the two-dimensional plan group was 18.64%, 6.78%, respectively, and the three dimensional plan was 5.08%, 0%, and the rectal D2cm3 in the two-dimensional plan group was more than 5. The percentage of 00C Gy is 6.78% and the three dimensional plan is 0% (P0.05). Conclusion: 1. Radiotherapy combined with chemotherapy is effective in the treatment of cervical cancer. It can improve the total survival rate and the non progression survival rate of five years. It is better than radiotherapy and radiotherapy combined with adjuvant chemotherapy. It is an ideal treatment for cervical cancer, but it also needs to pay attention to the treatment phase caused by concurrent chemoradiotherapy. For patients who are unable to tolerate concurrent chemoradiotherapy, adjuvant chemotherapy can also gain a higher survival benefit than radiotherapy alone..2 based CT based three-dimensional intracavitary radiotherapy plan for cervical cancer can significantly increase the coverage and dose of the tumor target area, which can effectively control the high dose area. Endanger the volume of organs in the domain is beneficial to reduce the occurrence of serious complications in the treatment of close distance, especially for the middle and late patients, the larger masses, the tumor target area and the complicated relationship between the organs and other conditions. However, the development time of the three-dimensional intracavity radiotherapy is short and the experience is limited, and the experience is compared with the traditional two dimensional technology, and the experience is constantly summed up. It can improve curative effect, reduce side effects and improve the quality of life of patients.
【學位授予單位】：蘇州大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R737.33

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