关键词: 宫颈癌, 3D打印微创导向模板, 插植放射治疗, 深部热疗

Abstract:  Objective To investigate the short-term efficacy and adverse reactions of 3D-printing minimally invasive-guided template implantation radiotherapy combined with deep hyperthermia in the treatment of locally advanced cervical cancer. Methods A total of 80 patients with cervical cancer newly treated in Hebei Province Cangzhou Hospital of Intergrated Traditional and Western Medicine from June 2018 to December 2020 were randomly divided into a combination treatment group and a single treatment group, with 40 cases in each group. In the single treatment group, the external irradiation was performed with 6 MV-X accelerator radiotherapy and cisplatin chemotherapy, the post loading treatment was treated with 192Ir high-dose rate universal source intracavitary radiotherapy, and the general tumor target area was irradiated 30-36 Gy, 5-6 times, 6 Gy each time, once a week. The external irradiation and synchronous chemotherapy in the combination treatment group were the same as those in the single treatment group; the implantation radiotherapy was performed under the guidance of 3D-printed minimally invasive-guided template, and the total dose and fractional dose were the same as those in the single treatment group; the deep hyperthermia was combined within 2 h after each implantation treatment. The short-term efficacy and adverse reactions of the two groups were compared, with regard to 90% target volume dose (D90), 100% prescription dose volume percentage (V100), and the exposure dose to 2 cm3 volume of bladder and rectum in organs at risk (D2 cm3). Results Two months after the treatment, the complete remission rate in the combination treatment group was significantly higher than that in the single treatment group (92.5% vs 72.5%, χ²=4.242, P=0.039), whereas there was no significant difference in partial remission rate and stable disease rate (χ²=2.635, P=0.193; χ²=3.117,  P=0.241). Compared with those of the single treatment group, the V100 and D90 of high-risk clinical target volume in the combination treatment group were significantly higher ［(79.83±6.31)% vs (87.35±4.38)%, t=6.685, P<0.001; (5.89±0.24) Gy vs (6.32±0.21) Gy, t=7.584, P<0.001］, the average dose of D2 cm3 rectum was significantly lower ［(3.50±0.27) Gy vs (3.25±0.36) Gy, t=-3.406, P=0.002］, but there was no significant difference in the average dose of bladder D2 cm3 ［(4.42±0.18) Gy vs  (4.37±0.25) Gy, t=-0.961, P=0.343］. There was no significant difference in the incidence of grade 1-2 radiation proctitis, radiation cystitis and grade 3 radiation cystitis between the two groups (all P>0.05), whereas the incidence of grade 3 radiation proctitis in the combination treatment group was significantly lower than that in the single treatment group (χ²=3.914, P=0.048). Conclusions In the treatment of locally advanced cervical cancer, the 3D-printed minimally invasive-guided template implantation radiotherapy combined with deep hyperthermia may significantly improve the short-term efficacy compared with the traditional 3D intracavity post-loading radiotherapy, with less adverse reactions. It also has advantages in the target dose and provides better protection for organs at risk.

Key words: Cervical cancer, 3D-printed minimally invasived-guited template, Interstitial radiotherapy, Deep hyperthermia