Californium-252 neutron intracavitary brachytherapy combined with external beam radiotherapy for cervical cancer: long-term outcomes of whole vs partial lead block of the pelvic fields during whole pelvic field irradiation

高华平; 陈永红; 雷新; 刘佳

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Californium-252 neutron intracavitary brachytherapy combined with external beam radiotherapy for cervical cancer: long-term outcomes of whole vs partial lead block of the pelvic fields during whole pelvic field irradiation

更新时间：2026-01-09

- Californium-252 neutron intracavitary brachytherapy combined with external beam radiotherapy for cervical cancer: long-term outcomes of whole vs partial lead block of the pelvic fields during whole pelvic field irradiation
- Journal of Army Medical University Vol. 37, Issue 10, Pages: 1040-1043(2015)
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  CLC： R181.32;R730.55;R737.33
- Published：2015
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高华平,陈永红,雷新,刘佳.锎-252中子内照射结合盆腔外照射治疗宫颈癌时全挡铅与半挡铅的长期疗效观察[J].陆军军医大学学报(原第三军医大学学报),2015,37(10):1040-1043.

　Gao Huaping,Cheng Yonghong,Lei Xin,Liu Jia.Californium-252 neutron intracavitary brachytherapy combined with external beam radiotherapy for cervical cancer: long-term outcomes of whole vs partial lead block of the pelvic fields during whole pelvic field irradiation[J].J Amry Med Univ (J Third Mil Med Univ),2015,37(10):1040-1043.
高华平,陈永红,雷新,刘佳.锎-252中子内照射结合盆腔外照射治疗宫颈癌时全挡铅与半挡铅的长期疗效观察[J].陆军军医大学学报(原第三军医大学学报),2015,37(10):1040-1043. DOI：

　Gao Huaping,Cheng Yonghong,Lei Xin,Liu Jia.Californium-252 neutron intracavitary brachytherapy combined with external beam radiotherapy for cervical cancer: long-term outcomes of whole vs partial lead block of the pelvic fields during whole pelvic field irradiation[J].J Amry Med Univ (J Third Mil Med Univ),2015,37(10):1040-1043. DOI：

摘要

目的比较锎-252中子内照射结合外照射治疗宫颈癌时盆腔野照射全挡铅与半挡铅的治疗结果。方法分别选取2007年3月至2008年10月、2009年5-12月各115例经病理活检确诊的临床分期为Ⅱa～Ⅲb期宫颈鳞癌患者作为研究对象，按照临床分期、年龄、肿瘤直径、贫血程度进行配对研究，分为盆腔野中央全挡铅组（全挡组）和半挡铅组(半挡组)。患者采用全盆外照射中间穿插锎-252中子内照射的治疗方式。全盆外照射采用前后对穿野照射，2 Gy/（次·d），4～5次/周，照射24～36 Gy后，全挡组盆腔野中央挡铅4 cm，而半挡组为盆腔野中央骶3以下部分挡铅4 cm，继续照射至48～54 Gy。中子内照射宫旁A点总剂量40～42 Gy，1次/周，10～12 Gy/次，共进行4次。全盆外照及锎-252腔内照射结束后，对宫旁仍有侵犯的Ⅲb期患者宫旁小野补量8～12 Gy。用McNemar test的方法比较严重急性期并发症（≥G2）发生率和总体生存率、绝对无病生存率、局部控制率及严重晚期并发症（放射性直肠炎和膀胱炎）（≥G2）发生率的差异。平均随访60.2个月。结果半挡组患者急性期胃肠道反应、放射性直肠炎、放射性膀胱炎发生率略高于全挡组，但两组差异均无统计学意义（P0.05）。半挡组患者的总体生存率、绝对无病生存率和局部控制率略高于全挡组，而盆腔淋巴结复发率和晚期并发症发生率略低于全挡组，但两组差异均无统计学意义（P0.05）。结论宫颈癌患者根治性放疗盆腔外照射时全挡铅与半挡铅的疗效相近，建议尽可能采取半挡铅照射技术。

Abstract

Objective To compare the long-term outcomes of whole lead block and partial lead block of the pelvic fields in the treatment of cervical cancer by external beam radiotherapy (EBRT) combined with californium-252 (252Cf) neutron intracavitary brachytherapy (ICBT). Methods From March 2007 to October 2008 and from May 2009 to December 2009

115 patients who had been diagnosed with stage ⅡA-ⅢB cervical squamous carcinoma by biopsy were enrolled and paired according to clinical stage

age

tumor size

and degree of anemia. They were divided into a whole lead block (WLB) group and a partial lead block (PLB) group during the whole pelvic field irradiation. For 252Cf ICBT

the total dose applied to point A was 40-42 Gy

9-11 Gy/f/w×4f. As for whole pelvis EBRT

anteroposterior (A-P) and posteroanterior (P-A) opposed fields were implemented. After 24-36 Gy irradiation

the pelvic field center was shielded with a 4 cm-thickness lead block in the WLB group

and the lead block was placed below S3 in the PLB group. The cumulative dose was 48-54 Gy. After EBRT

8-12 Gy irradiation should be boosted to the parametrial field if there was still parametrical invasion. McNemar test was employed to compare the severe acute complication (≥G2) incidence

overall survival rate

absolute disease-free survival rate

local control rate and severe late complication (radiation proctitis and radiation cystitis) (≥G2) incidence of the 2 groups. The mean follow-up time was 60.2 months. Results The incidences of acute gastrointestinal reaction

radiation proctitis

and radiation cystitis (≥G2) were higher in the WLB group than the PLB group (P0.05) though no significant difference was found. The overall survival rate

absolute disease-free survival rate

local control rate

pelvic lymph node recurrence rate and late complication incidence were higher in the WLB group thanin the PLB group. There were no statistically significant differences in the acute complication incidence

overall survival rate

absolute disease-free survival rate

local control rate

pelvic lymph node recurrence rate and late complication incidence between the 2 groups. Conclusion WLB of the pelvic fields has similiar efficiency as PLB in the treatment of cervical cancer by EBRT combined with 252Cf ICBT. So we recommend to employ the latter as much as possible.

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