Paris K J, Spanos W J, Day T G, Jose B, Lindberg R D
Department of Radiation Oncology, James Graham Brown Cancer Center, University of Louisville, KY 40292.
Int J Radiat Oncol Biol Phys. 1991 Sep;21(4):911-7. doi: 10.1016/0360-3016(91)90729-n.
Between 1980 and 1987, 298 patients with carcinoma of the uterine cervix were treated at the University of Louisville Department of Radiation Oncology. Of these, 197 (66.1%) were treated for cure by radiotherapy alone: 36 by external beam alone and 161 by external beam and tandem and ovoid applications. The F.I.G.O. staging of the 161 patients was 82 (50.1%) Stage IB, 9 (5.6%) Stage IIA, 40 (24.9%) Stage IIB, and 30 (18.6%) Stage III. The usual treatment was whole pelvis irradiation followed by two intracavitary applications using the Fletcher Suit Applicators of tandem and ovoids in 79/161 patients (49%), a 3-M Mini Applicator (Fletcher Suit Delcos Applicator) in 52/161 patients (32.3%), and a 3-M Mini Applicator with Caps in 30/161 patients (18.6%). The incidence of grade 3-4 gastrointestinal or genitourinary complications as defined by the RTOG was 19.3% (31/161). Various treatment parameters were analyzed to define possible contributing factors. Grade 3-4 complications were seen in 7.6% (6/79) of patients treated with the standard ovoid Fletcher system, 26.9% (14/52) treated with the mini-ovoid system, and 36.6% (11/30) treated with the mini-ovoid system with caps (p = .0006). Although trends were noted, neither the vaginal surface dose (VSD) from the ovoids nor the addition of the external beam dose to the VSD (total vaginal surface dose = TVSD) were significant independent variables (p = 0.19 and = 0.133, respectively). The TVSD was significant when comparisons were made between different ovoid systems (p = 0.05 for less than 12,000 cGy and p = 0.004 for greater than 12,000 cGy). In this study, the 3-M mini applicator was associated with a significant increase in grade 3-4 complications as compared to the Standard Fletcher Suit Applicator.
1980年至1987年间，路易斯维尔大学放射肿瘤学系收治了298例子宫颈癌患者。其中，197例（66.1%）仅接受放射治疗以治愈疾病：36例仅接受外照射，161例接受外照射以及宫腔管和卵圆体施源器治疗。161例患者的国际妇产科联盟（F.I.G.O.）分期为：IB期82例（50.1%），IIA期9例（5.6%），IIB期40例（24.9%），III期30例（18.6%）。常规治疗为全盆腔照射，随后79/161例患者（49%）使用弗莱彻套装施源器（宫腔管和卵圆体）进行两次腔内照射，52/161例患者（32.3%）使用3-M迷你施源器（弗莱彻套装德尔科斯施源器），30/161例患者（18.6%）使用带帽的3-M迷你施源器。根据美国放射肿瘤学组（RTOG）的定义，3 - 4级胃肠道或泌尿生殖系统并发症的发生率为19.3%（31/161）。分析了各种治疗参数以确定可能的影响因素。使用标准卵圆体弗莱彻系统治疗的患者中，3 - 4级并发症的发生率为7.6%（6/79）；使用迷你卵圆体系统治疗的患者中，发生率为26.9%（14/52）；使用带帽迷你卵圆体系统治疗的患者中，发生率为36.6%（11/30）（p = 0.0006）。尽管观察到了一些趋势，但卵圆体的阴道表面剂量（VSD）以及外照射剂量与VSD之和（总阴道表面剂量 = TVSD）均不是显著的独立变量（p分别为0.19和0.133）。当在不同的卵圆体系统之间进行比较时，TVSD具有显著差异（小于12,000 cGy时p = 0.05，大于12,000 cGy时p = 0.004）。在本研究中，与标准弗莱彻套装施源器相比，3-M迷你施源器与3 - 4级并发症的显著增加相关。
