Weitmann Hajo Dirk, Knocke Tomas Hendrik, Waldhäusl Claudia, Pötter Richard
Universitätsklinik für Strahlentherapie und Strahlenbiologie, Allgemeines Krankenhaus der Stadt Wien, Währinger Gürtel 18-20, 1090 Vienna, Austria.
Strahlenther Onkol. 2006 Feb;182(2):86-95. doi: 10.1007/s00066-006-1420-4.
In advanced vaginal recurrences of cervical and endometrial carcinomas therapeutic options are rare because of preceding therapy.
23 patients developing advanced vaginal recurrences of cervical and endometrial carcinomas were included. 15 patients started with external-beam therapy to the pelvis and eight patients after preceding radiotherapy underwent brachytherapy alone. All patients had ultrasound-guided implantation of transvaginal or transperineal interstitial needles for brachytherapy. Median prescribed total dose was 64 Gy.
18 patients (78%) achieved complete remission. Six patients are alive without tumor and one with tumor after a median follow-up of 64 months. 14 patients died of tumor and two of intercurrent disease. 5-year disease-specific survival and local control rate were 43% and 47%, respectively, in patients with complete remission. Univariate analysis found time to relapse > 2 years, initial diameter < or = 4 cm, initial volume < 15 cm(3), no extension to the pelvic side wall, volume before brachytherapy < 7.5 cm(3), brachytherapy coverage index > 0.8, and prescribed total dose > 64 Gy being positive predictors for local control and survival.
The use of ultrasound guidance for placement of interstitial needles in template-based brachytherapy of advanced recurrent gynecologic malignancies is a feasible, safe, and cheap method with encouraging results. Today, ultrasound imaging can be also used to some extent for treatment planning which requires further development. Patient- and treatment-related prognostic factors can be defined.
由于先前的治疗，宫颈癌和子宫内膜癌晚期阴道复发的治疗选择很少。
纳入23例发生宫颈癌和子宫内膜癌晚期阴道复发的患者。15例患者开始接受盆腔外照射治疗，8例先前接受过放射治疗的患者仅接受近距离放疗。所有患者均在超声引导下经阴道或经会阴植入组织间针进行近距离放疗。规定的中位总剂量为64 Gy。
18例患者（78%）实现完全缓解。中位随访64个月后，6例患者无瘤存活，1例患者带瘤存活。14例患者死于肿瘤，2例死于并发疾病。完全缓解患者的5年疾病特异性生存率和局部控制率分别为43%和47%。单因素分析发现，复发时间>2年、初始直径≤4 cm、初始体积<15 cm³、未累及盆腔侧壁、近距离放疗前体积<7.5 cm³、近距离放疗覆盖指数>0.8以及规定总剂量>64 Gy是局部控制和生存的阳性预测因素。
在晚期复发性妇科恶性肿瘤的模板式近距离放疗中，使用超声引导放置组织间针是一种可行、安全且廉价的方法，结果令人鼓舞。如今，超声成像在一定程度上也可用于治疗计划，这需要进一步发展。可以确定患者和治疗相关的预后因素。
