目的:探讨高剂量率192铱后装腔内加体外照射治疗宫颈癌的疗效及副作用等.方法:2005年3月至2007年1月本院放疗中心共60例宫颈癌患者,采用8MV-X线直线加速器全盆照射,开始体外全盆腔照射,5次/周,2Gy/次,剂量25-40Gy;然后中间挡铅,4个野照射,5次/周,2Gy/次,宫旁剂量20-25Gy:同时腔内治疗,1次/周,6Gy/次,剂量为35-40Gy.腔内治疗采用ZL-HDR18铱高剂量率后装治疗机,全部病例均宫颈阴道同时进行.腔内治疗每周1次,A点剂量36-40GY/6-7F/6-7w,腔内治疗当日停体外照射,治疗时间56-77天.结果:CR+PR 100%,随访超过3年,随访率达95%,3年生存率Ⅱ期88.3%,Ⅲ期82.9%; 早期放射性直肠反应发生率为 12.4%,膀胱反应发生率5.2% ;晚期放射性直肠炎发生率 13.8%,膀胱炎3.8%.结论:高剂量率192铱后装机腔内加体外治疗宫颈癌的疗效满意,患者生存率较高,耐受好,并发症少.%Objective:To study the therapeutic effect and complications of cervical carcinoma treated with HDR 192Ir afterloading intracavitary irradiation plus external beam radiation therapy( EBRT ). Methods: From March 2005 to January 2007,60 cervical cancer patients confirmed pathologically were treated with 8MV -X combination of HDR 192Ir afterloading intracavitary brachytherapy plus EBRT. A midplane dose of 25 -40Gy to the whole pelvis and additional 20 - 25 Gy EBRT to the parametrical areas were given. Intracavitary brachytherapy was delivered to a total dose of 36 -42 Gv at 6 Gy per fraction, once a week. Results:The rate of CR and PR was 100％. All patients were followed up over three years. The 3 -year survival rates for stage Ⅱ and Ⅲ stage lesions were 88.3％ and 82. 9％. Immediate radiation rectal reaction and cystitis were 12.4％ and 5.2％. Chronic radiation reaction rates were 13.8％ and 3.8％, respectively. Conclusion:HDR after loading intracavitary brachytherapy combined with EBRT is efective in treatment of carcinoma of uterine cervix. Meanwhile, the survival rate of patients is higher and the patient tolerated well with few complications.
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