Department of Radiation Oncology, Far Eastern Memorial Hospital, Taipei, Taiwan.
BMC Cancer. 2010 Nov 23;10:637. doi: 10.1186/1471-2407-10-637.
Stereotactic body radiation therapy (SBRT) administered via a helical tomotherapy (HT) system is an effective modality for treating lung cancer and metastatic liver tumors. Whether SBRT delivered via HT is a feasible alternative to brachytherapy in treatment of locally advanced cervical cancer in patients with unusual anatomic configurations of the uterus has never been studied.
A 46-year-old woman presented with an 8-month history of abnormal vaginal bleeding. Biopsy revealed squamous cell carcinoma of the cervix. Magnetic resonance imaging (MRI) showed a cervical tumor with direct invasion of the right parametrium, bilateral hydronephrosis, and multiple uterine myomas. International Federation of Gynecology and Obstetrics (FIGO) stage IIIB cervical cancer was diagnosed. Concurrent chemoradiation therapy (CCRT) followed by SBRT delivered via HT was administered instead of brachytherapy because of the presence of multiple uterine myomas with bleeding tendency. Total abdominal hysterectomy was performed after 6 weeks of treatment because of the presence of multiple uterine myomas. Neither pelvic MRI nor results of histopathologic examination at X-month follow-up showed evidence of tumor recurrence. Only grade 1 nausea and vomiting during treatment were noted. Lower gastrointestinal bleeding was noted at 14-month follow-up. No fistula formation and no evidence of haematological, gastrointestinal or genitourinary toxicities were noted on the most recent follow-up.
CCRT followed by SBRT appears to be an effective and safe modality for treatment of cervical cancer. Larger-scale studies are warranted.
体部螺旋断层放射治疗（SBRT）通过螺旋断层放疗（HT）系统进行，是治疗肺癌和转移性肝肿瘤的有效方法。通过 HT 实施的 SBRT 是否可作为治疗子宫解剖结构异常的局部晚期宫颈癌患者的近距离放疗的替代方法，尚未进行研究。
一名 46 岁女性因 8 个月的阴道异常出血就诊。活检显示宫颈鳞状细胞癌。磁共振成像（MRI）显示宫颈肿瘤直接侵犯右侧宫旁组织、双侧肾盂积水和多个子宫肌瘤。国际妇产科联合会（FIGO）分期为 IIIB 期宫颈癌。由于存在有出血倾向的多个子宫肌瘤，给予同步放化疗（CCRT）联合 HT 实施的 SBRT，而非近距离放疗。由于存在多个子宫肌瘤，在治疗 6 周后进行了全子宫切除术。由于存在多个子宫肌瘤，在 X 个月随访时行盆腔 MRI 或组织病理学检查均未发现肿瘤复发的证据。仅在治疗期间出现 1 级恶心和呕吐。在 14 个月随访时出现下消化道出血。在最近的随访中，未发现瘘管形成或血液学、胃肠道或泌尿生殖系统毒性的证据。
CCRT 后行 SBRT 似乎是治疗宫颈癌的一种有效且安全的方法。需要进行更大规模的研究。
