Clinical analysis of intensity modulated radiation therapy in cervical cancer patients with para-aortic lymph node metastasis after initial treatment

目的 对比单纯调强放疗(IMRT)与IMRT同步TP方案化疗治疗宫颈癌初始治疗后腹主动脉旁淋巴结(PALN)转移的疗效和不良反应.方法 选取2008年10月至2013年8月宫颈癌初始治疗后出现PALN转移的56例患者,PALN转移病灶给予放疗剂量GTV 55～60 Gy,CTV45 ～ 50 Gy,共25 ～ 30次,5～6周,接受同步放化疗(CRT组)者36例,单纯放疗(RT组)者20例.CRT组的同步化疗方案为TP方案,第1天紫杉醇135 mg/m2,顺铂60 mg/m2 2 d,21 d重复.单纯PALN转移(iPALN)患者33例,合并其他部位复发转移(niPALN)患者23例.结果 中位随访时间22.7个月(2.7 ～74.4个月).98.2％(55/56)的患者完成了放疗,CRT组中,38.9％的患者完成化疗2～3个周期,61.1％的患者完成化疗1个周期.CRT和RT组的有效率(CR +PR)分别为91.7％(33/36)和85％ (17/20)(x2=0.516,P＞0.05).两组患者的中位总生存(OS)时间为38和23个月,3年OS率分别为57.5％和32.7％ (x2 =4.059,P＜0.05),中位无进展生存时间(PFS)为68.3和16个月,3年PFS率分别为50.4％和29.2％(x2=4.184,P＜0.05).单纯PALN转移(iPALN)(33例)患者与合并其他部位复发转移(niPALN)患者(23例)的中位OS分别为71.2和21.4个月,3年OS率分别为53％和39.5％(x2=4.265,P＜ 0.05).CRT和RT组出现3或4级白细胞低下的患者分别为10例(27.8％)和6例(30％),3级消化道反应各有1例,差异均无统计学意义(x2=0.693、0.847,P＞ 0.05).结论 IMRT同步TP化疗对PALN转移的患者近期效果和远期生存均优于单纯放疗的患者,且不良反应可耐受.Objective To evaluate the efficacy and toxicities of intensity modulated radiation therapy (IMRT) with or without concurrent chemotherapy in the treatment of cervical cancer patients with para-aortic lymph node (PALN) metastases after initial treatment.Methods From Oct 2008 to Aug 2013,56 cervical cancer patients with PALN metastases after initial treatment,including radical resection or pelvic radiotherapy/chemoradiotherapy,were selected for analysis.The delivered radiation dose to PALN was 55-60 Gy for GTV and 45-50 Gy for CTV respectively with 25-30 fractions during 5-6 weeks.36 patients received concurrent paclitaxel (135 mg/m2) and cisplatin (60 mg/m2) chemoradiotherapy (CRT group) and 20 patients received RT alone (RT group).Results The median follow-up time after treatment was 22.7 months (2.7 to 74.4 months).98.2％ (55/56) of patients completed RT.In CRT group,38.9％ underwent concurrent TP regimen 2-3 cycles and the rest completed one cycle.The rates of CR plus PR in CRT and RT groups were 91.7％ (33/36) and 85％ (17/20),respectively (x2 =0.516,P ＞0.05).The 3-year overall survival rate in CRT group and RT group were 57.5％ and 32.7％ (x2 =4.059,P ＜ 0.05),and 3-year progression-free survival rates were 50.4％ and 29.2％ (x2 =4.184,P ＜ 0.05),respectively.TP regimen concurrent chemoradiotherapy was more effective than radiotherapy alone.The 3-year overall survival rate was 53％ and 39.5％ in patients with isolated PALN and nonisolated PALN,respectively (x2 =4.265,P ＜ 0.05).Grade 3 or 4 acute leukopenia was found in 10 (27.8％,CRT group) and 6 (30％,RT group) patients (x2 =0.693,P ＞ 0.05).Grade 3 gastrointestinal toxicity occurred in 1 patient each group (x2 =0.847,P ＞ 0.05).Conclusions TP regimen concurrent CRT is associated with better survival than RT alone,and the treatment toxicities could be tolerant.中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)7522-5273