Research Institute and Hospital, National Cancer Center, Republic of Korea.
Radiother Oncol. 2010 Dec;97(3):507-13. doi: 10.1016/j.radonc.2010.10.002. Epub 2010 Nov 11.
To identify the impact of 3D CT-based high-dose-rate intracavitary radiotherapy (ICR) on late rectal bleeding (LRB) and local control (LC) in patients with cervical cancer.
The outcomes of 97 consecutive patients treated with 3D CT-based ICR (3D-ICR) were compared with those of 133 consecutive historical patients with conventional 2D brachytherapy planning (2D-ICR). The median follow-up periods were 41 and 56 months for the 3D and 2D groups, respectively.
The overall rectal bleeding rate was similar between the groups (42% for 3D-ICR vs. 44% for 2D-ICR); however, the incidence of severe LRB was higher in the 2D-ICR group than in the 3D-ICR group (13% vs. 2%, respectively; p=0.02). In multivariate analysis, the factors associated with severe LRB were tumor >4 cm (12% vs. 3%) and 2D-ICR (10% vs. 2%). The LC rates were 97% and 91% for 3D-ICR and 2D-ICR, respectively (p=0.14); the progression-free survival rate was 80% for both groups. A significant difference in the LC rates between the two groups was observed in patients with larger tumor sizes with the tumor diameter of over 4 cm (98% vs. 81% by 3D-ICR vs. 2D-ICR, respectively; p=0.02).
The implementation of 3D-ICR in radiotherapy for cervical cancer can reduce the incidence of severe LRB and may improve the LC rate.
旨在确定基于 3D CT 的高剂量率腔内放疗（ICR）对宫颈癌患者晚期直肠出血（LRB）和局部控制（LC）的影响。
比较了 97 例连续接受基于 3D CT 的 ICR（3D-ICR）治疗的患者的结果与 133 例连续接受传统 2D 近距离治疗计划（2D-ICR）的历史患者的结果。3D 和 2D 组的中位随访时间分别为 41 个月和 56 个月。
两组的总体直肠出血率相似（3D-ICR 为 42%，2D-ICR 为 44%）；然而，2D-ICR 组严重 LRB 的发生率高于 3D-ICR 组（分别为 13%和 2%；p=0.02）。多因素分析显示，严重 LRB 的相关因素是肿瘤>4cm（12%比 3%）和 2D-ICR（10%比 2%）。3D-ICR 和 2D-ICR 的 LC 率分别为 97%和 91%（p=0.14）；两组的无进展生存率均为 80%。在肿瘤直径大于 4cm 的患者中，两组的 LC 率存在显著差异（3D-ICR 为 98%，2D-ICR 为 81%，分别为 3D-ICR 比 2D-ICR；p=0.02）。
宫颈癌放疗中实施 3D-ICR 可降低严重 LRB 的发生率，并可能提高 LC 率。
