摘要目的 观察老年宫颈癌患者调强放疗+腔内照射±化疗的不良反应和疗效,分析其预后影响因素. 方法 回顾性分析214例接受三维技术外照射+腔内照射±化疗的≥60岁宫颈癌患者的临床资料和随访结果.Kaplan-Meier法计算生存(OS)率,Log-rank法行预后单因素分析和Cox法行预后多因素分析. 结果 同步放化疗和单纯放疗患者3级以上骨髓抑制发生率分别为48.6％和15.8％,两组比较差异有统计学意义(x2=27.372,P＜0.05).同步放化疗和单纯放疗患者完全缓解(CR)率分别为83.0％和68.3％,两组比较差异有统计学意义(x2=5.993,P=0.014).全组1、3和5年OS率分别为92.2％、79.3％和65.6％.单因素分析显示,患者FIGO分期、淋巴结转移状况、病理类型和近期疗效是影响患者预后的因素(x2=4.321～30.316,均P＜0.05).多因素分析显示,FIGO分期、淋巴结转移状况、近期疗效是影响患者预后的独立因素(x2=5.284～14.261,均P＜0.05). 结论 老年宫颈癌患者采用调强放疗+腔内照射±化疗的治疗模式可取得良好的疗效和长期OS率,治疗毒副反应可耐受.FIGO分期、淋巴结转移状况、近期疗效是影响老年宫颈癌患者预后的独立因素.

abstractsObjective To investigate the adverse effects and clinical efficacy of the intensive modulated radiotherapy (IMRT)and intravaginal brachytherapy combined with versus without chemotherapy in elderly patients with cervical cancer,and to analyze its prognostic factors.Methods Clinical data and follow-up results of 214 patients with cervical cancer aged ≥60 years undergoing IMRT and intravaginal brachytherapy combined with or without chemotherapy were retrospectively analyzed.The overall survival(OS) rate was calculated by using the Kaplan-Meier method.Prognostic factors were analyzed by Log-rank single factor test and Cox multivariate analysis.Results The rates of myelosuppression(≥grade 3)was higher in the concurrent chemo-radiotherapy group than in simple radiotherapy group(48.6％％ vs.15.8 ％,x2 =27.372,P ＜ 0.05).The complete response (CR)rate was higher in the concurrent chemo-radiotherapy group than in the simple radiotherapy group (83.0％ vs.68.3％,x 2=5.993,P=0.014).The 1-,3-and 5-year OS rate were 92.2 ％,79.3 ％ and 65.6 ％,respectively in all patients.Univariate analysis showed that the staging,lymph node metastasis status,pathological type and short-term efficacy of cervical cancer (based on FIGO guideline)were influencing factors for the prognosis (x2 =4.321-30.316,all P ＜ 0.05).Multivariate analysis showed that the FIGO staging,lymph node metastasis status and short-term efficacy were independent influencing factors for the prognosis(x2 =5.284-14.261,all P＜0.05).Conclusions The intensive modulated radiotherapy and intravaginal brachytherapy combined with chemotherapy have a good efficacy and favorable long-term survival rate for the treatment of cervical cancer in elderly patients,and its major adverse effects can be tolerated.The FIGO staging,lymph node metastasis status and short-term efficacy are independent influencing factors for the prognosis in elderly patients with cervical cancer.