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目的探讨核素锎(252Cf)中子腔内后装加盆腔外照射治疗中晚期宫颈鳞癌的疗效。方法回顾性分析2003年1月至2006年1月就诊于新疆自治区人民医院和新疆医科大学附属肿瘤医院的Ⅱb～Ⅳa期宫颈鳞癌病例共110例。所有患者均进行腔内后装加盆腔外照射治疗,分成2组:一组为252Cf组,采用252Cf中子腔内后装加盆腔外照射治疗65例;另一组为核素铱(192Ir)组,采用192Ir腔内后装加盆腔外照射治疗45例。比较两组的症状缓解率、局部病灶控制的有效率、副反应的发生率及随访3年者的生存率。结果252Cf组与192Ir组均能够有效缓解阴道流血、排液以及腰腹痛、排便困难等症状,差异无统计学意义(P>0.05),但252Cf组生殖道及盆腔感染和贫血缓解率高于192Ir组,差异有统计学意义(P<0.05)。252Cf组症状缓解起效时间早于192Ir组(P<0.05)。252Cf组局部病灶控制总有效率为98.46%,192Ir组为95.56%,差异无统计学意义(P>0.05)。但252Cf组局部病灶控制起效时间早于192Ir组(P<0.05)。252Cf组副反应发生率低于192Ir组(P<0.05)。252Cf组随访3年患者的3年生存率(88.46%)高于192Ir组(75.00%),差异有统计学意义(P<0.05)。结论252Cf腔内后装加盆腔外照射治疗宫颈鳞癌,能够较迅速有效地控制症状,缩减局部肿瘤,副反应发生率较低,3年生存率较高。
Objective To investigate the curative effect of radionuclide (252Cf) neutron afterloading and extra-pelvic irradiation on advanced cervical squamous cell carcinoma. Methods A total of 110 cases of cervical squamous cell carcinoma of stage Ⅱb ~ Ⅳa who visited our hospital from January 2003 to January 2006 in Xinjiang Uygur Autonomous Region People’s Hospital and Xinjiang Medical University Affiliated Tumor Hospital were retrospectively analyzed. All patients were treated with intracameral posterior plus extra-pelvic irradiation and divided into two groups: one was 252Cf group, 252Cf neutron cavity was loaded with extra-pelvic external irradiation, and the other was iridium nuclide (192Ir) Group, the use of 192Ir after posterior plus pelvic external irradiation in 45 cases. Symptomatic remission rate, effective rate of local lesion control, incidence of side effects and survival rate of 3-year follow-up were compared between the two groups. Results 252Cf group and 192Ir group were able to effectively relieve vaginal bleeding, discharge and waist pain, defecation and other symptoms, the difference was not statistically significant (P> 0.05), but 252Cf group genital tract and pelvic infection and anemia remission rate higher than 192Ir Group, the difference was statistically significant (P <0.05). The onset of symptom relief in 252Cf group was earlier than that in 192Ir group (P <0.05). The total effective rate of local control in 252Cf group was 98.46%, 95.56% in 192Ir group, the difference was not statistically significant (P> 0.05). However, 252Cf group local lesion control onset earlier than the 192Ir group (P <0.05). The incidence of side effects in 252Cf group was lower than that in 192Ir group (P <0.05). The 3-year survival rate (88.46%) in the 252Cf group was significantly higher than that in the 192Ir group (75.00%) after 3 years of follow-up. The difference was statistically significant (P <0.05). Conclusion 252Cf intracavitary posterior plus pelvic extracorporeal radiotherapy for cervical squamous cell carcinoma can control the symptoms more quickly and effectively and reduce the local tumor. The incidence of side effects is low and the 3-year survival rate is high.