婦癌病人一天照射兩次之文獻回顧及個人經驗

Hyerfractionation Radiotherapy in the Gynecological Cancers: Literature Review and Personal Experience

詹建勝(Jian-Sheng Jan) ； 張慶雄(Ching-Shysiong Chang) ； 林進清(Jin-Ching Lin) ； 翁益強(Yih-Chyang Weng) ； 高忠恕(Jong-Shuh Gau)

《放射治療與腫瘤學》 1卷1期 (1994/03) Pp. 43-46

https://doi.org/10.6316/TRO/199401(1)43

摘要

一天照射兩次之放射線治療技術，對較晚期之顯頸部癌，已有許多文獻報告，可以增加局部之腫瘤控制率，而已廣氾地被使用。但運用在婦科腫瘤如子宮癌則很少，本院於81年會以此方法治療兩個病例，一例為復發性子宮頸癌，一例為11B期子宮頸癌，均以一天照射兩次每次間隔6小時以上，早上照射前後照野1.8葛雷，下午照射兩側照野1.2葛雷。共照射15天，45葛雷，然後改用一般治療方法，第二例有加3天之cisplatin 作為放射敏感劑，兩例之腫瘤控制都很好，已維持17個月，但兩例均有較明顯之急性反應包括腹瀉，裡急後重，白血球降低等，需休息一至二周。文獻報告方面，只有兩篇用此技術治療子宮頸癌，結果腫瘤控制並沒有比一般治療方法增加，而急性反應則有很明顯的增加。由於用一天照射兩次之技術應用在婦癌方面可能增加一些急性副作用，而腫瘤控制率並沒有明顯增加，故很少使用。

並列摘要

That the radiotherapy with hyperfractionation technique can improve the local tumor control rate has been reported in lots of literature in therapy for advanced head and neck cancers and other cancers but little in gynecological cancers. In 1992 we treated 2 cases with carcinoma of the uterine cervix by two fractions per day. Case I had recurrent tumor in the vaginal cuff and case II had FIGO stage IIB disease. Both cases received hyperfractionation with 1.8 Gy from AP and PA portals in the morning and 1.2 Gy from bilateral opposing portals in the afternoon at interval of at least 6 hours. We delivered up to 45 Gy in lsdays, rested for 1-2 weeks, and then changed the dose as in the conventional radiotherapy with 2 Gy per day. Case I totally received 72.6 Gy in 43 fractions in 59 days. Case II received 65 Gy in 40 fractions in 45 days. Case II also received concomitant chemotherapy with 30 mg cisplatin for 3 days in the second week of radiotherapy as a radiation sensitizer and intracavitary brachytherapy to the uterine cavity with 500 cGy to point A for each treatment and totally for 5 treatments after external radiotherapy. After radiotherapy both cases developed moderate to severe acute reactPons including diarrhea, tenesmus and low white count in 2 weeks of the hyperfractionation treatment. But the acute reactions were soon recovered after a rest of 1-2 weeks. In our follow-up as of July 1993, there was no late complication and the case were with good local controland without distant metastasis up to 17 months. The literature, review demonstrated only 2 reports regarding hyperfractionation of the gynecological cancershad been reported. The local tumor control in is 2 reports did not show any significant improvement and the increased acute normal tissue reactions showed in one report. In conclusion, hyperfractionation technique for gynecological cancers may induce more acute reactions but may not increase the local control rate, so, it is not frequently applied in the therapy for gynecological cancers.