目的：本研究目的在分析第二期B與第三期B子宮頸癌病人接受全放射治療中，加入預防性主動脈旁淋巴區照射與合併化學治療的初期存活成果與治療相關副作用分析。材料與方法：1998年6月至2001年6月間，20位第二期B或第三期B子宮頸癌且無主動脈旁淋巴腺轉移的病人，被納入本研究分析中。治療組合包括全程骨盆腔放射治療，預防性主動脈旁淋巴區放射治療，合併放射治療療程中的化學治療，與放射治療療程結束後的化學治療。放射治療設計有45 Gy/25次的主動派旁淋巴區體外放射治療，50.4Gy/28次的骨盆腔體外放射治療，9 Gy/5次的子宮頸旁軟組織的加強體外放射治療，以及Point A 4-5次共計22-30 Gy的體腔內近接放射治療。化學治療包括放射療程中第1及29天共兩次的cisplatinum 60-80 mg/m2 ，以及放射療程後1及2個月的cisplatinum 60-80 mg/m2和連續注射 5 日的 5-fluorouracil 600- 800 mg/m2 ，病人治療結束後定期返回門診追蹤檢查。存活成果分析以Kaplan-Meier 方法分析，治療相關副作用以RTOG標準評定，中位數追蹤時間為15個月。結果：所有病人皆完成原定的放治療及放射療程中的兩次合併化學治療，16位病人（80%）另完成了放射療程後的兩次化學治療，其中4位病人在化學治療藥物上有所調整。1位病人追蹤時出現局部復發，2年局部控制率為83%，另一位病人出現肺部轉移，沒有病人出現主動脈旁淋巴復發，所有病人均仍存活，2年存活率為100%。所有病人皆沒有第四度的急性副作用，大多數的治療相關副作用為腸胃道及血液系統的反應，四位病人（20%）出現第3度腸胃道副作用，五位病人（25%）出現第3度血液系統副作用，僅有2位病人出現超過2度以上的長期併發症。沒有病人因為治療副作用而造成放射治療療程延誤或中斷。結論：全程放射治療中加入預防性主動脈旁淋巴區放射治療及合併化學治療，對第二期B及第三期B的子宮頸癌病人是安全且可忍受的治療方式。初期存活成果是足以接受的，本研究需要更長時間的追蹤，以確認這種強度的組合治療方式的控制成效和治療副作用。

Purpose: This study was to analyze the preliminary survival outcomes and treatment-related toxicities of definitive radiotherapy with prophylactic para-aortic irradiation and concurrent chemotherapy for patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIB/IIIB cervical carcinoma. Materials and Methods: From June 1998 to June 2001, 20 patients with FIGO stage IIB or IIIB cervical carcinoma with no lymph node metastasis to the para-aortic area were included in the study. Patients were treated with definitive pelvic and prophylactic para-aortic radiotherapy, concomitant chemotherapy, and post-radiation chemotherapy Radiation treatments included external radiation to the para-aortic area with 45 Gy in 25 fractions and to the whole pelvis with 50.4 Gy in 28 fractions, additional boost to the parametrium with 9 Gy in 5 fractions, and the intracavitary brachytherapy with point A doses of 22-30 Gy in 4-5 fractions. Chemotherapy included 2 cycles of cisplatinum 60-80 mg/m2 on day 1 and day 29 during radiotherapy , and 2 cycles of cisplatinum 60-80 mg/m2 and 5-fluorouracil 600-800 mg/m2/day for 5 days, at 1 and 2 months after completion of radiotherapy. Patients were followed on a regular basis. The survival outcome was calculated by Kaplan-Meier method, and the treatment-related side effects were evaluated by RTOG criteria. The median follow-up interval was 15 months. Results: All patients completed the planned radiotherapy and the planned 2 cycles of chemotherapy during radiotherapy. Sixteen patients (80%) underwent 2 cycles of the post-radiation chemotherapy, while 4 of them had modification of chemotherapy regimens. One patient had local recurrence, with the 2-year local control rate of 83%. None of the 20 patients had para-aortic recurrence, but one patient developed lung metastasis. All patients were alive and the 2-year survival rate was 100%. Most treatment-related side effects were gastrointestinal and hematological reactions. No patient had grade IV acute toxicity. For gastrointestinal toxicity, there were four patient(20%) with grade III reaction. For hematological toxicity, there were five patients (25%) with grade III reaction. All but 2 patients had the late toxicities less than or equal to grade II. No patient had the interruption of radiation therapy due to the treatment-related adverse effects. Conclusion: Definitive radiotherapy with prophylactic para-aortic irradiation and concur-rent chemotherapy are safe and well tolerated for patients with FIGO stage IIB-IIIB cervical carcinoma. The preliminary survival results were acceptable. Long-term follow-up is needed to evaluate the side effects and outcome with this intensive treatment combination.