Park Hee-Chul, Suh Chang Ok, Kim Gwi Eon
Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Med J. 2002 Dec;43(6):737-48. doi: 10.3349/ymj.2002.43.6.737.
It is well known that intracavitary radiotherapy (ICR), either alone or in combination with external-beam radiotherapy (EBRT) is an essential component of the radiation treatment of uterine cervical cancer. Although low-dose-rate (LDR) brachytherapy has been successfully applied to the management of such patients, several radiation oncologists have experience of using high-dose-rate (HDR) brachytherapy with promising clinical results over the past 4 decades. However, there has been a considerable reluctance by radiation oncologists and gynecologists in North America to employ the HDR remote afterloading technique instead of the more firmly established LDR treatment modality. In contrast, the HDR-ICR system is rapidly gaining acceptance in Korea since the introduction of the Ralstron, remotely controlled afterloading system using HDR Co-60 sources, at the Yonsei Cancer Center in 1979. According to brachytherapy statistics reported by the Korean Society of Therapeutic Radiology and Oncology, in 1997, brachytherapy was performed upon 1,758 Korean patients with uterine cervical cancer, of whom approximately 83% received HDR brachytherapy. In this review, we present our experiences of HDR-ICR for the treatment of uterine cervical cancer. In addition, we discuss the controversial points, which are raised by those considering the use of HDR-ICR for uterine cervical cancer; these issues include physical and radiobiological considerations, and the prospect of future technical improvements.
众所周知，腔内放射治疗（ICR），无论是单独使用还是与体外放射治疗（EBRT）联合使用，都是子宫颈癌放射治疗的重要组成部分。尽管低剂量率（LDR）近距离放射治疗已成功应用于此类患者的治疗，但在过去40年中，一些放射肿瘤学家已经有使用高剂量率（HDR）近距离放射治疗并取得了令人鼓舞的临床结果的经验。然而，北美地区的放射肿瘤学家和妇科医生相当不愿意采用HDR远程后装技术，而更倾向于使用更为成熟的LDR治疗方式。相比之下，自1979年延世癌症中心引入使用HDR钴-60源的远程控制后装系统Ralstron以来，HDR-ICR系统在韩国迅速得到认可。根据韩国放射治疗与肿瘤学会报告的近距离放射治疗统计数据，1997年，1758名韩国子宫颈癌患者接受了近距离放射治疗，其中约83%接受了HDR近距离放射治疗。在本综述中，我们介绍了我们使用HDR-ICR治疗子宫颈癌的经验。此外，我们还讨论了那些考虑使用HDR-ICR治疗子宫颈癌的人提出的有争议的问题；这些问题包括物理和放射生物学方面的考虑，以及未来技术改进的前景。
