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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)     (16點)
Result of Radiotherapy in the Treatment of Uterine Cervical Cancer and Analysis of Late Rectal Complications (Five Years Experience at Skmh)
著者:陳尚文(Shang-Wen Chen) ;林芳仁(Fang-Jen Lin) ;梁基安(Ji-An Liang) ;楊世能(Shih-Neng Yang) ;劉瑞燦(Ruey-Tsan Liu) ;涂振邦(Cheng-Pang Tu) ;蕭安成(An-Cheng Shiau) ;吳學鼎(Tsieh-Ting Wu)
出版地區:台灣
出版城市:台北市
學科:醫學綜合
關鍵字:子宮頸癌 ; 放射治療 ; 高劑量率(HDR)子宮腔內近接治療 ; 直腸後遺症 ; Carcinoma of the uterine cervix ; Radiotherapy ; HDR brachytherapy ; Late rectal complications
刊名:放射治療與腫瘤學
頁碼:11-18
語言:繁體中文
摘要: 中文摘要PDF ; 英文摘要PDF

到重﹒ 子宮頸癌是目前台灣婦女發生率最高的宿症, 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。 鐘起盟主主主: 從1 99 2 年9 月至1 99 4 年1 2 月, 共有1 09 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。開始的治療範囝涵蓋整個子宮,陰道及下腹腔淋巴腺﹒經照射的Gy至4 4 Gy 後,依腫瘤期別縮小範圍至兩側的子宮旁組織( parametr ium ) 子宮腔內治療次數3次,問隔一週,每次給予參考點A ( point A) 7.2 Gy 的劑量, 針對年紀較大及直腸累積放射劑量較高的病態、則依情況調整p o i n t A 劑量至5 G y 或6 Gy 0 109 位病患中有1 0 2 例( FIGO stage 1b-lIa 24 人. lib 48 人. III糾l i b 2 6 人﹒ IVa-b 4 人) 接受追踩檢查而進入分析。 益基: 102 位病息經過30 至54 個月的追~檢查( 中位值39 個月) . 至1 9 9 7 年1 2 月底止﹒ 仍存活者共有的人(其中一人已有遠處轉移). 37 人己死亡, 其中8 人死於局部復發. 1 6 人死於遠處轉移, 1 人死局部復發合併遠處聽移. 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l率分別為I b- I l a 95 % / 95 % ' lib 84 % / 92 % . IIla-lIlb 50 % / 78 % ' IV25 % / 50 %) 。針對的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2 6 人(30.2 %) 發生直腸後遺症( RTOG grade I 14 人. grade II 8 人, grade III-IV 4 人) . 經分析後發現F I GOstage lib-IV ' 直腸放射劑量( 遠隔治療+ 所有近接治療的I C R U 直腸劑量) 大於6 5 旬, 以及總治療時間超過7 0天者為高危儉群。 益畫畫: 研究結果顯示sta ge I lI a-lll b 病患的治療結果仍須進一步加以改善。因有1 8 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3 0 %會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漿, 在不影響治療結果的前提下﹒ 自治療計劃的調整,進而,成少後遺症發生的機率。
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 extemal 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 ( lIb ca e 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 wa 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-Ila, 48 Ilb, 26 Illa-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 reun'ence, 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 lb-Ila, 84%/92% for lIb, 50%/78% for Illa-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 gastrointestinal complication. Twenty-six patients (30.2%) was noted to have late rectal sequale (RTOG gradeI 14. gradell 8, gradefll-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 lib-IV cases, total rectal dose (external RT + totallCRU rectal dose) > 65 Gy, and overall treatment time> 70 days. Conclusion: Our current study show the treatment outcome of Figo IIIa-lIlb 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.


    

本卷期目次
放射治療與腫瘤學
Outpatient Continuous Infusional Chemotherapy with Ambulatory Infusional Puma-The Early Experience of Outpatient Chemotherapy Unit at the Veterans General Hospital-Taipei/ S. Y. ChenL. L. LiangS. L. ChangM. L. MengS. H. YenC. K. LowK. H. ChiK. Y. Chen
Inverted Papilloma with Sarcomatoid Carcinoma in the Nasal Cavity: A Case Report/ Wen-Haw SuMeng-Haw WuKou-Hwa Chang
Relief of Dysphagia by Palliative Intracavitary Brachytherapy for Recurrent Esophageal Cancer Two Cases Report/ Yih-Chyang WengHsien-Chun TsengLeon L. Y. ChenJian-Sheng Jan
Palliative Radiotherapy for Synchronous Brain Metastases from Lung Cancer/ Ching-Yhe HsiungStephen Wan LeungSing-Kai LoChong-Jong WangHui-Chun ChenLi-Min SunFu-Min Fang
以等中心點相切照野技術治療乳癌患者時之對側乳房劑量評估及屏蔽效應/ 洪茂欽梁雲廖宗義呂宗憲吳嘉明
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)/ 陳尚文林芳仁梁基安楊世能劉瑞燦徐振邦蕭安成吳學鼎
參加史丹佛大學強度調變放射治療(IMRT)研習會心得簡報/ 王重榮陳翰森梁雲
Retrospective Study of Pediatric Acute Leukemia/ Ming-Yii HuangChih-Jen HuangShi-Long LianJen-Yang TangYu-Hui Ho
Establishment and Characterization of Genetically Modified Cancer Cells for Experimental Cancer Therapy/ Rang-Lang YenYuh-Chuen CheChih-Hong LoHung-Hsueh ChouChieh-Sheng Tsai
Establishment and Characterization of Genetically Modified Cancer Cells for Experimental Cancer Therapy/ 顏榮郎車玉春羅志宏周宏學蔡介生
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)/ 陳尚文林芳仁梁基安楊世能劉瑞燦涂振邦蕭安成吳學鼎
Outpatient Continuous Infusional Chemotherapy with Ambulatory Infusional Pump-The Early Experience of Outpatient Chemotherapy Unit at the Veterans General Hospital-Taipei/ S. Y. ChenL. L. LiangS. L. ChanglM. L. MengS. H. YenC. K. LowK. H. ChiK. Y. Chen
Palliative Radiotherapy for Synchronous Brain Metastases from Lung Cancer/ Ching-Yeh HsiungStephen-Wan LeungSing-Kai LoChong-Long WangHui-Chun ChenLi-Min SunFu-Min Fang
Retrospective Study of Pediatric Acute Leukemia/ Ming-Yii HuangChih-Jen HuangShi-Long LianJen-Yang TangYu-Hui Ho
以等中心點相切照野技術治療乳癌患者時之對側乳房劑量評估及屏蔽效應/ 洪茂欽梁雲廖宗義呂宗憲吳嘉明
Inverted Papilloma with Sarcomatoid Carcinoma in the Nasal Cavity: A Case Report/ Wen-Haw SuMeng-Haw WuKou-Hwa Chang
Relief of Dysphagia by Palliative Intracavitary Brachytherapy for Recurrent Esophageal Cancer-Two Cases Report/ Yih-Chyang WengHsien-Chun TsengLeon L. Y. ChenJian-Sheng Jan
參加史丹佛大學強度調變放射治療(IMRT)研習會心得簡報/ 王重榮陳翰森梁雲
 
   
 
   

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