Wieners Gero, Pech Maciej, Rudzinska Malgorzata, Lehmkuhl Lukas, Wlodarczyk Waldemar, Miersch Alexandra, Hengst Susanne, Felix Roland, Wust Peter, Ricke Jens
Klinik für Strahlenheilkunde, Charité, Campus Virchow Klinikum, Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
Eur Radiol. 2006 Nov;16(11):2586-93. doi: 10.1007/s00330-006-0241-2. Epub 2006 Apr 20.
The purpose was to evaluate the safety and efficacy of high-dose-rate (HDR) CT-guided interstitial brachytherapy in the treatment of extrahepatic, extrapulmonary, secondary malignancies. Nineteen patients were included in this prospective study. The median age was 66 years (49-77). Underlying primaries comprised colorectal carcinomas in six, renal cell carcinoma in three, pancreatic carcinoma in three, cervical cancer in two, endometrial cancer in two and NSCLC, breast cancer and sarcoma in one patient each. All patients had undergone extensive pretreatments. CT-guided HDR brachytherapy employed a 192Iridium source. Dose planning for brachytherapy was performed using 3D CT data acquired after CT-guided percutaneous applicator positioning. MRI follow-up was performed 6 weeks and every 3 months post intervention. Primary endpoints were complications, local tumor control and progression-free survival. The median tumor diameter was 6 cm (2-15 cm). Tumor locations included the hepatoduodenal ligament, mesentery, adrenal gland, mesogastrium and local recurrences after rectal or pancreatic cancer. The minimal median dose in the target volume was 11 Gy (4-18 Gy). Minor complications comprised pain and fever (n=6, 32%). Major complications included one hospital death of unknown causes (n=1; 5%). Median follow-up was 7 months (1-16). Four patients (21%) died during the follow-up period. Local tumor control was 76.5% after 6 months and progression-free survival 47% after 6 months. Minimally invasive CT-guided HDR brachytherapy is safe and effective in the palliative treatment of extrahepatic, extrapulmonary secondary malignancies.
本研究旨在评估高剂量率（HDR）CT引导下组织间近距离放射治疗肝外、肺外继发性恶性肿瘤的安全性和有效性。本前瞻性研究纳入了19例患者。中位年龄为66岁（49 - 77岁）。原发肿瘤包括6例结直肠癌、3例肾细胞癌、3例胰腺癌、2例宫颈癌、2例子宫内膜癌，以及1例非小细胞肺癌、1例乳腺癌和1例肉瘤。所有患者均接受了广泛的预处理。CT引导下的HDR近距离放射治疗采用铱-192源。近距离放射治疗的剂量规划使用CT引导下经皮施源器定位后获取的三维CT数据进行。干预后6周及之后每3个月进行一次MRI随访。主要终点为并发症、局部肿瘤控制和无进展生存期。肿瘤中位直径为6 cm（2 - 15 cm）。肿瘤部位包括肝十二指肠韧带、肠系膜、肾上腺、胃系膜以及直肠癌或胰腺癌后的局部复发。靶区最小中位剂量为11 Gy（4 - 18 Gy）。轻微并发症包括疼痛和发热（n = 6，32%）。主要并发症包括1例不明原因的医院死亡（n = 1；5%）。中位随访时间为7个月（1 - 16个月）。4例患者（21%）在随访期间死亡。6个月时局部肿瘤控制率为76.5%，6个月时无进展生存率为47%。微创CT引导下的HDR近距离放射治疗在肝外、肺外继发性恶性肿瘤的姑息治疗中安全有效。
