Demanes D J, Rodriguez R R, Bendre D D, Ewing T L
California Endocurietherapy Cancer Center, Oakland 94609, USA.
Int J Radiat Oncol Biol Phys. 1999 Aug 1;45(1):105-12. doi: 10.1016/s0360-3016(99)00124-8.
To report the clinical outcome for cervical carcinoma treated with external beam pelvic radiotherapy and interstitial high dose rate (IS-HDR) brachytherapy.
Between July 1991 and June 1996, 62 patients with locally advanced stage cervical carcinoma or early stage carcinoma that precluded satisfactory tandem and ovoid insertion were treated. Most patients received 36 Gy (range: 25 Gy-45 Gy) external beam radiotherapy (EBRT) to the pelvis prior to brachytherapy implant. EBRT was continued, with central shielding, to a dose of 50 Gy to the pelvic sidewalls. HDR Iridium-192 brachytherapy was given in 6 fractions of 5.5 to 6.0 Gy. The mean follow-up was 40 months.
Stage distribution was: Stage IB (12), Stage IIA (1), Stage IIB (26), Stage IIIA (6), Stage IIIB (13), and Stage IVA (4). The overall local tumor control was 94%. Local control rates by FIGO stage were Stage I (12/12) 100%, Stage II (25/27) 93%, Stage III (18/19) 95%, and Stage IV (3/4) 75%. The regional pelvic control rates were overall 81%, Stage I (12/12) 100%, Stage II (22/27) 81%, Stage III (15/19) 79%, and Stage IV (1/4) 25%. Distant metastasis developed in 20 patients (32%). The actuarial 5-year disease-free survival was for all patients 48%, Stage I 81%, Stage II 47%, Stage III 39%, and Stage IV O%. Grade 3-4 delayed morbidity resulting from treatment, occurred in 6.5% (4/62) of patients. A fistula without local recurrence occurred in 1.6% (1/62) patients.
We report excellent local and regional pelvic control results using a 6 fraction IS-HDR brachytherapy protocol for cervical carcinoma. The incidence of severe complications is low and suggests that a consistent brachytherapy technique and multiple HDR fractions are therapeutically advantageous to patients treated for cervical carcinoma.
报告盆腔外照射放疗联合组织间高剂量率（IS-HDR）近距离放疗治疗宫颈癌的临床结果。
1991年7月至1996年6月期间，对62例局部晚期宫颈癌患者或因早期宫颈癌无法顺利插入宫腔管和卵圆体的患者进行了治疗。大多数患者在近距离放疗植入前接受了36 Gy（范围：25 Gy - 45 Gy）的盆腔外照射放疗（EBRT）。EBRT继续进行，采用中心屏蔽，使盆腔侧壁剂量达到50 Gy。HDR铱-192近距离放疗分6次给予，每次5.5至6.0 Gy。平均随访时间为40个月。
分期分布为：IB期（12例）、IIA期（1例）、IIB期（26例）、IIIA期（6例）、IIIB期（13例）和IVA期（4例）。总体局部肿瘤控制率为94%。按国际妇产科联盟（FIGO）分期的局部控制率为：I期（12/12）100%、II期（25/27）93%、III期（18/19）95%、IV期（3/4）75%。盆腔区域控制率总体为81%，I期（12/12）100%、II期（22/27）81%、III期（15/19）79%、IV期（1/4）25%。20例患者（32%）发生远处转移。所有患者的精算5年无病生存率为48%，I期81%、II期47%、III期39%、IV期0%。治疗引起的3 - 4级延迟并发症发生率为6.5%（4/62）。1.6%（1/62）的患者发生了无局部复发的瘘管。
我们报告了采用6分次IS-HDR近距离放疗方案治疗宫颈癌能取得优异的局部和盆腔区域控制结果。严重并发症的发生率较低，这表明一致的近距离放疗技术和多次HDR分次对宫颈癌患者在治疗上具有优势。
