目的 探讨 192 Ir 组织间插植宫旁加量放疗在局部晚期宫颈癌(LACC)治疗中的应用价值。 方法 前瞻性随机对照研 究纳入重庆大学附属三峡医院 2023 年 8 月至 2025 年 2 月 104 例 LACC 患者,通过随机数字表法按 2 ∶ 1 随机分为试验组 (69 例)与对照组(35 例),最终 96 例完成治疗及随访(试验组 64 例、对照组 32 例)。 两组均行盆腔外照射联合同步化疗,试 验组加用 192 Ir 组织间插植宫旁加量放疗,对照组采用常规腔内后装放疗(ICBT)。 比较两组靶区剂量学参数、危及器官受量、 近期疗效、Karnofsky 评分、营养指标(血清白蛋白、前白蛋白、体重变化)及不良反应。 结果 试验组高危临床靶区 90%靶区体 积所接受的最小辐射剂量(D90) (86. 2±5. 3) Gy 高于对照组( 83. 5± 3. 2) Gy,适形度指数( 0. 85± 0. 06) 高于对照组( 0. 76± 0. 05),均匀性指数(0. 15±0. 04)低于对照组(0. 23±0. 05)(均 P<0. 05);试验组直肠最小 2 cm 3 受照剂量(D2cc)(70. 3±4. 2)Gy、 膀胱 D2cc(71. 5±3. 9)Gy 低于对照组(均 P<0. 05)。 治疗后 1 个月,试验组完全缓解率(76. 56%)高于对照组(P<0. 05);治 疗后 3 个月,试验组 Karnofsky 评分改善率(45. 3%)、血清白蛋白(38. 5±3. 2) g / L、前白蛋白(235. 6±28. 4) mg / L 均高于对照 组,体重下降率(12. 5%)、患者主观整体评估(PG-SGA) C 级比例(6. 2%)及放射性肠炎发生率(42. 19%)低于对照组(均 P< 0. 05)。 结论 192 Ir 组织间插植宫旁加量放疗可优化 LACC 患者靶区剂量分布,提高肿瘤控制率,改善短期生活质量及营养状 态,且不增加急性期严重不良反应。

Objective To explore the application value of 192 Ir interstitial implantation paracervical boost radiotherapy in the treatment of locally advanced cervical cancer LACC . Method A prospective randomized controlled study enrolled 104 LACC patients from August 2023 to February 2025 who were randomized at a 2 ∶ 1 ratio using a random number table method into an experimental group n = 69 and a control group n = 35 . Finally 96 patients completed the treatment and follow-up 64 in the experimental group and 32 in the control group . Both groups received pelvic external beam radiotherapy combined with concurrent chemotherapy. The experimental group was additionally treated with 192 Ir interstitial implantation paracervical boost radiotherapy while the control group received conventional intracavitary brachytherapy ICBT . The two groups were compared in terms of target volume dosimetric parameters radiation doses to organs at risk short - term therapeutic efficacy Karnofsky performance score KPS nutritional indicators serum albumin prealbumin body weight change and adverse reactions. Result In the experimental group the D90 dose covering 90% of the target volume of the high-risk clinical target volume HR-CTV was 86. 2±5. 3 Gy which was higher than that of the control group 83. 5±3. 2 Gy the conformity index CI was 0. 85±0. 06 which was higher than that of the control group 0. 76±0. 05 and the homogeneity index HI was 0. 15±0. 04 which was lower than that of the control group 0. 23±0. 05 all P<0. 05 . The D2cc dose to 2 cm 3 of the organ of the rectum 70. 3±4. 2 Gy and bladder 71. 5±3. 9 Gy in the experimental group were lower than those in the control group both P<0. 05 . One month after treatment the complete response CR rate in the experimental group 76. 56% was higher than that in the control group P<0. 05 . Three months after treatment the improvement rate of KPS 45. 3% serum albumin level 38. 5±3. 2 g / L and prealbumin level 235. 6±28. 4 mg / L in the experimental group were all higher than those in the control group whereas the rate of weight loss 12. 5% proportion of patients with PG-SGA grade C 6. 2% and incidence of rectal toxicity 42. 19% were lower than those in the control group all P < 0. 05 . Conclusion 192 Ir interstitial implantation paracervical boost radiotherapy can optimize the target volume dose distribution in LACC patients improve tumor control rate enhance short-term quality of life and nutritional status without increasing the incidence of severe acute-phase adverse reactions.