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題 名 | 子宮頸癌放射治療的結果及直腸後遺症的分析(新光醫院的五年經驗)=Result of Radiotherapy in the Treatment of Uterine Cervical Cancer and Analysis of Late Rectal Complications (Five Years Experience at SKMH) |
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作 者 | 陳尚文; 林芳仁; 梁基安; 楊世能; 劉瑞燦; 涂振邦; 蕭安成; 吳學鼎; | 書刊名 | 放射治療與腫瘤學 |
卷 期 | 5:1 1998.03[民87.03] |
頁 次 | 頁11-18 |
分類號 | 417.2832 |
關鍵詞 | 子宮頸癌; 放射治療; 高劑量率子宮腔內近接治療; 直腸後遺症; Carcinoma of the uterine cervix; Radiotherapy; HDR brachytherapy; Late rectal complications; |
語 文 | 中文(Chinese) |
中文摘要 | 目的:子宮頸癌是目前臺灣婦女發生率最高的癌症,本研究主要在檢討新光醫 院五年來放射線治療子宮頸癌的初步結果,並分析因治療而引發之直腸副作用的可能因素 而改善將來的治療計劃。 材料與方法:從1992年9月至1994年12月,共有109位子宮頸癌病人在新光醫院完成放射線 治療,放射線治療包括遠隔治療與子宮腔內近接治療。開始的治療範圍涵蓋整個子宮,陰 道及下腹腔淋巴腺,經照射40 Gy至44 Gy後,依腫瘤期別縮小範圍至兩側的子宮旁組織( parametrium)子宮腔內治療次數3次,間隔一週,每次給予參考點A(point A)7.2 Gy的劑 量,針對年紀較太及直腸累積放射劑量較高的病患則依情況調整point A劑量至5 Gy或6 Gy。109位病患中有102例(FIGO state Ib-IIa24人,IIb48人,IIIa-IIIb26人,IVa-b4人 )接受追蹤檢查而進入分析。 結果:102位病患經過30至54個月的追蹤檢查(中位值39個月),至1997年12月底止,仍存 活者共有65人(其中一人已有遠虛轉移),37人已死亡,其中8人死於局部復發,16人死於 遠處轉移,1人死局部復發合併遠處轉移,3人死於治療所引發的後遺症,9人死於其它疾 病。三年存活率與下腹腔腫瘤控制率分別為Ib-IIa10 95% / 96%.,IIb84% / 92%, IIIa-IIIb 50% / 78%,IV26% / 50%)。針對86位存活時間超過一年的病患進行大腸 後遺症的分析,其結果顯示共有26人(30.2%)發生直腸後遺症(RTOG graed I 14人, grade II 8人,grade III-IV 4人),經分析後發現FIGO stageIIb-IV,直腸放射劑囊(遠 隔治療+所有近接治療的ICRU直腸劑量)大於65 Gy,以及總治療時間起過70天者為高危險 群。 結論:研究結果顯示stage IIIa-IIIb病患的治療結果仍須進一步加以改善。因有18例( 17.6%)的病患發生遠處轉移,應評估選定高危險的病人進行化學治療之臨床研究。以目 前近接治療的方式,約有30%曾發生不同程度的放射線直腸炎,未來應繼續分析引發直腸 後遺症的因素,在不影響治療結果的前提下,由治療計劃的調整,進而減少後遺症發生的 機率。 |
英文摘要 | Introduction : Cancer of the uterine cervix is the most prevalent female cancer in Taiwan. Our study is to analyse the treatment outcome of cervical cancer in the past five years at Shin Kong Memorial Hospital. In order to refine future treatment protocol, the possible risk factors of late rectal complications will also be analysed. Materials & Methods : From September 1992 to December 1994, 109 patients with uterine cervical cancer completed planned radiotherapy (RT) at Shin Kong Memorial Hospital. Treatment consisted of external beam RT followed by HDR (high dose rate) intracavitary brachytherapy. After external RT dose of 40-44 Gy to whole pelvis, bilateral parametrium of stage ( IIb cases were further boosted to 54~58 Gy with central shielding. Intracavitary brachytherapy consisted of three to four insertions with intervals of one week. The prescribed dose of each insertion was 7.2 Gy to point A, while in some circumstances (old age or high cumulative rectal dose), point A dose had been modified to 5~6 Gy. One hundred and two cases (24 Ib-IIa, 48 IIb, 26 IIIa-b, 4 IVa) received follow-up and were enrolled for the study. Results : After 30 to 54 months of follow-up (median 39 months), 65 cases was alive (one was noted to have distant metastasis), 37 cases died of disease (8 for local reurrence, 16 for distant metastasis, one for both), 3 cases died of complication, while 9 cases were dead due to intercurrent disease. The 3- year cause-specific survival and local control rates are 95%/95% for Ib-IIa, 84%/92% for IIb, 50%/78% for IIIa-b, 25%/50% for stage IV, respectively. A total of 86 cases who survived more than one year were further analysed to define the risk factors of late aastrointestinal complication. Twenty-six patients (30.2%) was noted to have late rectal sequale (RTOG gradeI 14, gradeII 8, gradeIII-IV 4), while four cases (4.6%) developed ileus. Logistic regression analysis demonstrated a high risk of late rectal sequale in those who were stage 1Ib-IV cases, total rectal dose (external RT + total ICRU rectal dose) > 65 Gy, and overall treatment time > 70 days. Conclusion : Our current study show the treatment outcome of Figo IIIa-IIIb cases is not satisfactory. Because 18 patients (17.6%) were noted to have distant metastases, it might be recommended to select high risk patients to undergo adjuvant chemotherapy. With our present tratment proctocol, there will be about 30% of cases to have different extent of radiation proctitis. We will continue to analyse possible risk factors of late rectal complications and promote the therapeutic gain of HDR brachytherapy based treatment planning. |
本系統中英文摘要資訊取自各篇刊載內容。