Nag S, Erickson B, Parikh S, Gupta N, Varia M, Glasgow G
The Ohio State University, Columbus, OH 43210, USA.
Int J Radiat Oncol Biol Phys. 2000 Oct 1;48(3):779-90. doi: 10.1016/s0360-3016(00)00689-1.
To develop recommendations for use of high-dose-rate (HDR) brachytherapy in patients with endometrial cancer.
A panel of members of the American Brachytherapy Society (ABS) performed a literature review, supplemented their clinical experience, and formulated recommendations for endometrial HDR brachytherapy.
The ABS endorses the National Comprehensive Cancer Network (NCCN) guidelines for indications for radiation therapy for patients with endometrial cancer and the guidelines on HDR quality assurance of the American Association on Physicists in Medicine (AAPM). The ABS made specific recommendations for HDR applicator selection, insertion techniques, target volume definition, dose fractionation, and specifications for postoperative adjuvant vaginal cuff therapy, for vaginal recurrences, and for medically inoperable primary endometrial cancer patients. The ABS recommends that applicator selection should be based on patient and target volume geometry. The dose prescription point should be clearly specified. The treatment plan should be optimized to conform to the target volume whenever possible while recognizing the limitations of computer optimization. Suggested doses were tabulated for treatment with HDR alone, and in combination with external beam radiation therapy (EBRT), when applicable. For intravaginal brachytherapy, the largest diameter applicator should be selected to ensure close mucosal apposition. Doses should be reported both at the vaginal surface and at 0.5-cm depth irrespective of the dose prescription point. For vaginal recurrences, intracavitary brachytherapy should be restricted to patients with nonbulky (< 0.5-cm thick) disease. Patients with bulky (> 0.5-cm thick) recurrences should be treated with interstitial techniques. For medically inoperable patients, an appropriate applicator that will allow adequate irradiation of the entire uterus should be selected.
Recommendations are made for HDR brachytherapy for endometrial cancer. Practitioners and cooperative groups are encouraged to use these recommendations to formulate their treatment and dose reporting policies. This will lead to meaningful comparisons of reports from different institutions and lead to advances and appropriate use of HDR.
制定关于高剂量率（HDR）近距离放射治疗子宫内膜癌患者的建议。
美国近距离放射治疗学会（ABS）的一组成员进行了文献综述，补充了他们的临床经验，并制定了子宫内膜HDR近距离放射治疗的建议。
ABS认可美国国立综合癌症网络（NCCN）关于子宫内膜癌患者放射治疗适应症的指南以及美国医学物理学家协会（AAPM）的HDR质量保证指南。ABS针对HDR施源器选择、插入技术、靶区定义、剂量分割以及术后辅助阴道袖口治疗、阴道复发和医学上无法手术的原发性子宫内膜癌患者的规范提出了具体建议。ABS建议施源器选择应基于患者和靶区的几何形状。应明确规定剂量处方点。治疗计划应尽可能优化以符合靶区，同时认识到计算机优化的局限性。列出了单独使用HDR以及在适用时与外照射放疗（EBRT）联合使用时的建议剂量。对于阴道内近距离放射治疗，应选择最大直径的施源器以确保黏膜紧密贴合。无论剂量处方点如何，都应在阴道表面和0.5厘米深度处报告剂量。对于阴道复发，腔内近距离放射治疗应限于病变不大（<0.5厘米厚）的患者。病变较大（>0.5厘米厚）的复发患者应采用组织间技术治疗。对于医学上无法手术的患者，应选择能够充分照射整个子宫的合适施源器。
提出了关于子宫内膜癌HDR近距离放射治疗的建议。鼓励从业者和合作组使用这些建议来制定他们的治疗和剂量报告政策。这将有助于对不同机构的报告进行有意义的比较，并推动HDR的发展和合理应用。
