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目的观察~(232)Cf 中子腔内照射加全盆腔外照射治疗子宫内膜癌的3年局部控制率、生存率、远期并发症以及预后影响因素。方法选择40例未接受过任何治疗,按照国际妇产科联盟(FIGO)1971年临床分期标准诊断为临床Ⅰb～Ⅳa期的子宫内膜癌患者作为研究对象。其中,Ⅰb期15例,Ⅱ期15例,Ⅲ期8例,Ⅳa期2例;腺癌30例,腺鳞癌6例,乳头状腺癌4例;G_1 25例,G_2～G_315例。治疗方案:~(252)Cf 中子腔内照射,A 点总剂量为35～45 Gy(i),F 点总剂量为38～50 Gy(i)。治疗间歇穿插全盆腔外照射,前后对穿野,外照射剂量达20～30 Gy 后,盆腔野中央屏蔽挡铅4 cm,四野外照射治疗,使总剂量达到45～50 Gy,总疗程5～6周。患者均随访36个月以上。结果患者的3年局部控制率为88%(35/40),总生存率为75%(30/40)。其中,Ⅰb期3年局部控制率为93%(14/15),总生存率为87%(13/15),虽高于Ⅱ期患者的80%(12/15)和87%(13/15),但差异无统计学意义(P>0.05);明显高于Ⅲ～Ⅳ期的60%(6/10)和50%(5/10),差异有统计学意义(P<0.01)。G_1患者的3年局部控制率为92%(23/25),总生存率为88%(22/25),明显高于 G_2～G_3患者的80%(12/15)和53%(8/15),差异有统计学意义(P<0.01)。腺癌患者的3年局部控制率为93%(28/30),总生存率为87%(26/30),明显高于腺鳞癌及乳头状腺癌的70%(7/10)和30%(3/10),差异有统计学意义(P<0.01)。所有患者Ⅱ级以上远期放射性膀胱炎的发生率为2%(1/40),Ⅱ级以上远期放射性直肠炎和乙状结肠炎的发生率为10%(4/40)。结论 ~(252)Cf 中子腔内照射加全盆腔外照射治疗子宫内膜癌具有较好的临床应用前景。子宫内膜癌的临床分期、病理类型和病理分级足重要的预后影响因素。
Objective To observe the 3-year local control rate, survival rate, long-term complication and prognostic factors of ~ (232) Cf neutron and total pelvic external irradiation for endometrial cancer. Methods Forty patients with endometrial cancer who did not receive any treatment and were diagnosed as stage Ⅰb-Ⅳa according to the clinical stage statistic of 1971 by the International Federation of Gynecology and Obstetrics (FIGO) were selected as the study objects. There were 15 cases of stage Ib, 15 cases of stage II, 8 cases of stage III and 2 cases of stage IVa. There were 30 cases of adenocarcinoma, 6 cases of adenosquamous carcinoma and 4 cases of papillary adenocarcinoma. Treatment: ~ (252) Cf neutron cavity irradiation, the total dose of point A 35 ~ 45 Gy (i), F point total dose of 38 ~ 50 Gy (i). Intermittent treatment of intermittent pelvic external irradiation, before and after the field, external dose of 20 ~ 30 Gy, the pelvic field shielding central block lead 4 cm, four fields outside the radiation treatment, the total dose of 45 ~ 50 Gy, the total course of treatment of 5 ~ 6 weeks. Patients were followed up for more than 36 months. Results The 3-year local control rate was 88% (35/40) and the overall survival rate was 75% (30/40). Among them, the 3-year local control rate of stage Ib was 93% (14/15), the overall survival rate was 87% (13/15), although higher than 80% (12/15) and 87% (13 / 15), but the difference was not statistically significant (P> 0.05); it was significantly higher than 60% (6/10) and 50% (5/10) of stage Ⅲ ~ Ⅳ, the difference was statistically significant (P <0.01). The 3-year local control rate of G_1 patients was 92% (23/25), the overall survival rate was 88% (22/25), significantly higher than 80% (12/15) and 53% (8 / 15), the difference was statistically significant (P <0.01). The three-year local control rate of adenocarcinoma patients was 93% (28/30), the overall survival rate was 87% (26/30), which was significantly higher than that of adenosquamous carcinoma and papillary adenocarcinoma (70%, 7/10) and 30% (3/10), the difference was statistically significant (P <0.01). The incidence of long-term radiation cystitis in grade Ⅱ and above was 2% (1/40) in all patients. The incidence of long-term radiation proctitis and sigmoiditis in grade Ⅱ and above was 10% (4/40). Conclusion ~ (252) Cf neutron irradiation combined with external pelvic irradiation for endometrial cancer has good clinical application prospects. Endometrial cancer clinical stage, pathological type and pathological grade are important prognostic factors.