2 种调强放疗技术联合紫杉醇脂质体同步治疗Ⅱ B- Ⅲ B 期宫颈癌的临床疗效比较

Clinical comparative study of two kinds of intensity-modulated radiotherapy regimens combined with paclitaxel liposome in treatment of cervical cancer in stage Ⅱ B and Ⅲ B

摘要:

目的 探讨适形调强放疗（IMRT）和容积旋转调强放疗（VMAT）2 种调强放疗技术联合紫杉醇脂质体同步治疗Ⅱ B- Ⅲ B 期宫颈癌的临床疗效和安全性差异。方法 选取青海大学附属医院2014 年5 月-2016 年5 月收治Ⅱ B- Ⅲ B 期宫颈癌患者80 例。以随机数字表法分为A 组和B 组，每组40 例，分别在紫杉醇脂质体化疗基础上同步采用IMRT 和VMAT 辅助治疗；比较两组患者近期疗效、中位总生存时间（OS）、中位无进展生存时间（PFS）、中位远处转移时间（DMR）、中位局部复发时间（LRR）、治疗前后卡氏评分（KPS）及药物毒副作用发生率等。结果 两组患者近期疗效比较，差异无统计学意义（P >0.05）；两组患者中位OS、PFS、DMR 及LRR 时间比较，差异无统计学意义（P >0.05）；A、B 组患者治疗后KPS 评分与治疗前比较，差异有统计学意义（P <0.05），B 组患者治疗后KPS 评分高于A 组；两组患者放射性直肠炎、放射性膀胱炎、消化道反应及肝功能损伤发生率比较，差异无统计学意义（P >0.05）；B 组患者骨髓抑制发生率与A 组比较，差异有统计学意义（P <0.05），B 组低于A 组。结论 IMRT 和VMAT 分别联合紫杉 醇脂质体同步治疗Ⅱ B- Ⅲ B 期宫颈癌在控制疾病进展、延长生存时间及降低转移复发风险方面效果接近；但VMAT 方案可有效降低骨髓抑制发生风险，提高日常生活质量。

Abstract:

Objective To investigate clinical effect and safety differences of intensity-modulated radiotherapy (IMRT) and volume-modulated arc therapy (VMAT) combined with paclitaxel liposome in the treatment of cervical cancer in stage Ⅱ B and Ⅲ B. Methods Eighty patients with cervical cancer of stage Ⅱ B and Ⅲ B treated in our hospital from May 2014 to May 2016 were chosen and randomly divided into two groups including group A(40 patients) with IMRT and group B (40 patients) with VMAT on the basis of paclitaxel liposome. The short-term clinical efficacy, the median time of overall survival (OS), progression free survival (PFS), distant metastasis (DM) and local recurrence (LR), the KPS scores before and after treatment and the incidences of drug side effects were compared between both groups. Results There was no significant difference in the short-term clinical efficacy between the 2 groups (P > 0.05). There was no significant difference in the median time of OS, PFS, DM or LR between the 2 groups (P > 0.05). The KPS scores of the group B after treatment were significant higher than those before treatment and those of the group A (P < 0.05). There was no significant difference in the incidence of factitial proctitis, radiocystitis, digestive tract reaction or liver function damage between the 2 groups (P > 0.05). The incidence of bone marrow suppression after treatment in the group B was significantly lower than that in the group A (P < 0.05). Conclusions In the treatment of cervical cancer in stage Ⅱ B and Ⅲ B, IMRT and VMAT combined with paclitaxel liposome possess the same effects in controlling disease progression, prolonging survival time and reducing metastasis and recurrence risks. However, VMAT can efficiently lower the risk of bone marrow suppression and improve the quality of life.