[Occurrence of radiation-induced injury in vagina after radical radiotherapy of cervical cancer and its affecting factors].

Objective: To investigate the occurrence and degree of radiation-induced injury in vagina after radical radiotherapy of cervical cancer. Methods: A total of 282 cases of patients with cervical cancer were collected from November 2016 to September 2017. All of the above patients underwent radical radiotherapy from 2008 to 2017 in the First Affiliated Hospital of Xi'an Jiaotong University. The patients' International Federation of Gynecology and Obstetrics (FIGO) staging (2009) , brachytherapy dose, whether receive synchronous chemotherapy or not, age and body mass index (BMI) for the occurrence and severity of vaginal radiation injury at different time periods were analyzed by cross-sectional survey method. The single factor would be analyzed by the method of Chi-square test and the multiple factors would be analyzed by logistic regression method to checkout. Results: Of the 282 patients, the incidence of radiation-injury in vaginal was 84.4% (238/282) , with the incidence rate of degree Ⅰ,Ⅱ and Ⅲ radiation injury were respectively 50.7% (143/282), 29.8% (84/282) and 3.9% (11/282; χ(2)=153.375, P<0.05) , and there was no degree Ⅳ. Until the end of the follow-up time, the incidence of radiation-induced injury in vaginal after completing the treatment within 1 year, 1-2 years,>2-<5 years and ≥5 years were respectively 80.0% (24/30) , 87.2% (102/117) , 88.2% (60/68) and 77.6% (52/67; χ(2)=4.231, P=0.238) . There were 30 cases be followed within 1 year after treatment, the incidence rate of degreeⅠ,Ⅱ and Ⅲ of radiation injury in vagina was 60.0% (18/30) , 20.0% (6/30) and 0, respectively (χ(2)=28.636, P<0.05). There were 117 cases be followed between 1-2 years after treatment, the incidence rate of degreeⅠ,Ⅱ and Ⅲ vaginal radiation-induced injury were 54.7% (64/117) , 29.9% (35/117) and 2.6% (3/117) , respectively (χ(2)=77.198, P<0.05) . There were 68 cases be followed between >2-<5 years after treatment, the incidence rate of degree Ⅰ,Ⅱ and Ⅲ vaginal radiation-induced injury were 51.5% (35/68) ,33.8% (23/68) and 2.9% (2/68) , respectively (χ(2)=39.525, P<0.05) . There were 67 cases be followed ≥5 years after treatment, the incidence rate of degree Ⅰ,Ⅱ and Ⅲ vaginal radiation injury were 38.8% (26/67) , 29.9% (20/67) and 9.0% (6/67) , respectively (χ(2)=16.395, P<0.05) . The single-factor analysis result indicated that the brachytherapy dose had an obvious effect on vaginal radiation-induced injury (χ(2)=5.344, P=0.021) ; however, other factors, such as age, BMI, FIGO stages and synchronous chemotherapy, had no obvious effect on vaginal radiation-induced injury (all P>0.05) . The multifactor analysis indicated that the brachytherapy dose was an independent factor affecting the occurrence of vaginal radiation-induced injury (P=0.043) . Conclusion: After the radical radiotherapy of cervical cancer, the vaginal radiation-induced injury is associated with the dose of brachytherapy.目的： 探讨子宫颈癌根治性放疗后阴道放射性损伤的发生情况，并分析其影响因素。 方法： 采用横断面调查方法收集2008年1月至2017年4月在西安交通大学第一附属医院接受根治性放疗（即体外放疗联合腔内后装放疗），并于2016年11月至2017年9月在本院门诊复查，且具有完整临床病理资料的子宫颈癌患者共282例，其年龄为（56±9）岁（28~78岁），随访治疗结束后不同时间（包括<1年、1~2年、>2~<5年、≥5年）子宫颈癌患者阴道放射性损伤的发生率及损伤程度；并分析患者年龄、体质指数（BMI）、临床分期[按国际妇产科联盟（FIGO）2009年的临床分期标准]、后装放疗剂量、是否同步化疗对阴道放射性损伤发生的影响，单因素分析采用χ(2)检验，多因素分析采用logistic回归法。 结果： 282例子宫颈癌患者中，238例患者出现阴道放射性损伤，总发生率为84.4%（238/282）；其中，Ⅰ、Ⅱ和Ⅲ度阴道放射性损伤的发生率分别为50.7%（143/282）、29.8%（84/282）和3.9%（11/282），3者比较，差异有统计学意义（χ(2)=153.375，P<0.05），无Ⅳ度阴道放射性损伤发生。至随访截止时间，随访时间<1年、1~2年、>2~<5年、≥5年的子宫颈癌患者阴道放射性损伤的发生率分别为80.0%（24/30）、87.2%（102/117）、88.2%（60/68）和77.6%（52/67），不同随访时间患者阴道放射性损伤的发生率比较，差异无统计学意义（χ(2)=4.231，P=0.238）。随访时间<1年的患者有30例，其Ⅰ、Ⅱ、Ⅲ度阴道放射性损伤的发生率分别为60.0%（18/30）、20.0%（6/30）、0，3者比较，差异有统计学意义（χ(2)=28.636，P<0.05）；随访时间为1~2年的患者有117例，其Ⅰ、Ⅱ、Ⅲ度阴道放射性损伤的发生率分别为54.7%（64/117）、29.9%（35/117）、2.6%（3/117），3者比较，差异有统计学意义（χ(2)=77.198，P<0.05）；随访时间为>2~<5年的患者有68例，其Ⅰ、Ⅱ、Ⅲ度阴道放射性损伤的发生率分别为51.5%（35/68）、33.8%（23/68）、2.9%（2/68），3者比较，差异有统计学意义（χ(2)=39.525，P<0.05）；随访时间≥5年的患者有67例，其Ⅰ、Ⅱ、Ⅲ度阴道放射性损伤的发生率分别为38.8%（26/67）、29.9%（20/67）、9.0%（6/67），3者比较，差异有统计学意义（χ(2)=16.395，P<0.05）。单因素分析显示，后装放疗剂量对阴道放射性损伤的发生有明显影响（χ(2)=5.344，P=0.021）；而患者年龄、BMI、临床分期、是否同步化疗对阴道放射性损伤的发生均无明显影响（P均>0.05）。多因素分析显示，后装放疗剂量为影响阴道放射性损伤发生的独立危险因素（P=0.043）。 结论： 子宫颈癌根治性放疗后引起的阴道放射性损伤可能与后装放疗剂量明显相关。.