Kolotas Christos, Röddiger Sandra, Strassmann Gerd, Martin Thomas, Tselis Nikolaos, Aebersold Daniel M, Baltas Dimos, Zamboglou Nikolaos
Department of Radiation Oncology, Offenbach Hospital, Offenbach, Germany.
Strahlenther Onkol. 2003 Jul;179(7):458-63. doi: 10.1007/s00066-003-0921-7.
To report the methods and clinical results of CT-based interstitial high-dose-rate (HDR) brachytherapy procedures for the palliative treatment of recurrent rectal cancer.
A total of 44 brachytherapy implants were performed in 38 patients. CT-guided catheter implants were performed in 34 patients under local anesthesia and sedation, and four patients were implanted intraoperatively. Of 40 CT-guided implants, 20 were done using metallic needles introduced via the sacrum and 20 were transperineal implants of plastic tubes in the presacral region. Postimplant CT scans were used for three-dimensional (3-D) conformal brachytherapy planning. Patients implanted with metallic needles were given a single fraction of 10-15 Gy using HDR (192)Ir, and those who received transperineal implants of plastic catheters were given fractionated brachytherapy, 5 Gy twice daily to a total dose of 30-40 Gy. The median tumor volume was 225 cm(3) with a range of 41-2,103 cm(3).
After a median follow-up of 23.4 months, a total of 13/38 patients were alive. The median postbrachytherapy survival was 15 months with 18 of the 25 deaths due to distant metastases. Tumor response was as follows: 6/38 partial remission, 28/38 stable disease, and 4/38 local progression. A planning target volume (PTV) coverage > 85% was achieved in 42/44 implants. The treatment was well tolerated, and no acute complications were observed. One patient developed a fistula after 8 months. Pain relief was recorded in 34 patients (89.5%), and the median duration of this palliative effect was 5 months with a range of 1-13 months.
Interstitial HDR brachytherapy is a valuable tool for the delivery of high doses and achieves effective palliation in recurrent rectal carcinoma.
报告基于CT的组织间高剂量率（HDR）近距离放射治疗复发性直肠癌姑息治疗的方法及临床结果。
38例患者共进行了44次近距离放射治疗植入。34例患者在局部麻醉和镇静下接受CT引导下的导管植入，4例患者在术中植入。在40例CT引导下的植入中，20例使用经骶骨插入的金属针，20例为在骶前区域经会阴植入塑料管。植入后CT扫描用于三维（3-D）适形近距离放射治疗计划。植入金属针的患者单次给予10 - 15 Gy的HDR（192）铱，接受经会阴塑料管植入的患者接受分次近距离放射治疗，每日两次，每次5 Gy，总剂量30 - 40 Gy。肿瘤中位体积为225 cm³，范围为41 - 2103 cm³。
中位随访23.4个月后，38例患者中共有13例存活。近距离放射治疗后中位生存期为15个月，25例死亡中有18例死于远处转移。肿瘤反应如下：38例中有6例部分缓解，28例病情稳定，4例局部进展。44次植入中有42次计划靶体积（PTV）覆盖率> 85%。治疗耐受性良好，未观察到急性并发症。1例患者在8个月后发生瘘管。34例患者（89.5%）记录到疼痛缓解，这种姑息效果的中位持续时间为5个月，范围为1 - 13个月。
组织间HDR近距离放射治疗是一种用于高剂量照射的有价值工具，可有效缓解复发性直肠癌症状。
