Kucera H, Pötter R, Knocke T H, Baldass M, Kucera E
Department of Gynecology and Obstetrics, University of Vienna, Austria.
Wien Klin Wochenschr. 2001 Jan 15;113(1-2):58-62.
To retrospectively compare the clinical outcome in cervical cancer patients treated by external irradiation and intracavitary high-dose rate (HDR) brachytherapy with iridium 192 versus low-dose rate (LDR) brachytherapy with radium 226 or caesium 139.
450 LDR patients were treated from 1982 to 1986 and compared with 189 HDR patients treated from 1993 to 1999. Cobalt (CO) 60 treatment was replaced in the HDR group by modern megavoltage photon radiotherapy (Linac 25 MV). Brachytherapy was given in either 2 or 3 LDR radium 226 implants for the earlier patient cohort, and 3-6 HDR iridium 192 implants for the latter cohort. The primary endpoint assessed was the 3-year overall survival.
The median duration of follow-up was 70 months (range, 2-108 months) in the LDR group and 34 months (range, 4-69 months) in the HDR group. Actuarial overall 3-year survival after conventional LDR brachytherapy was 51.3%, versus 58.2% after HDR brachytherapy. No difference in 3-year survivors was seen in the small groups of stage I (68.3% vs. 84.6%) and stage IV (23.1% vs. 37.5%) patients. In stage II and III and in the overall group there were statistically significantly more 3-year survivors in the HDR group (58.1% vs. 78.9%, p < 0.001 in stage II; 37.3% vs. 53.8%, p < 0.01 in stage III; and 46.7% vs. 67.2%, p < 0.001 in the total group). Retrospectively assessed complication rates in the former LDR group were 3.8% for irreversible side effects, and 13.3% for chronic radiation damage. In the HDR group the actuarial late complication rates for grades 3 and 4 were 2.9% for the bladder, 4.0% for the bowel, and 6.1% for the rectum.
In our preliminary experience, HDR brachytherapy combined with external beam radiation produced similar and even better survival rates compared with the LDR series. HDR brachytherapy combined with external beam radiation is an efficient method for the treatment of cervical cancer and adverse side effects are comparable.
回顾性比较宫颈癌患者接受外照射联合铱 192 高剂量率（HDR）近距离放疗与镭 226 或铯 139 低剂量率（LDR）近距离放疗的临床结果。
1982 年至 1986 年治疗了 450 例 LDR 患者，并与 1993 年至 1999 年治疗的 189 例 HDR 患者进行比较。HDR 组中钴（CO）60 治疗被现代兆伏光子放疗（直线加速器 25MV）取代。早期患者队列采用 2 次或 3 次 LDR 镭 226 植入进行近距离放疗，后者队列采用 3 - 6 次 HDR 铱 192 植入。评估的主要终点是 3 年总生存率。
LDR 组的中位随访时间为 70 个月（范围 2 - 108 个月），HDR 组为 34 个月（范围 4 - 69 个月）。传统 LDR 近距离放疗后的 3 年精算总生存率为 51.3%，而 HDR 近距离放疗后为 58.2%。I 期（68.3%对 84.6%）和 IV 期（23.1%对 37.5%）患者的小队列中 3 年生存率无差异。在 II 期和 III 期以及总体组中，HDR 组的 3 年生存者在统计学上显著更多（II 期：58.1%对 78.9%，p < 0.001；III 期：37.3%对 53.8%，p < 0.01；总体组：46.7%对 67.2%，p < 0.001）。LDR 组回顾性评估的不可逆副作用并发症发生率为 3.
