Department of Radiation Oncology, Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Gunma, Japan.
J Radiat Res. 2011;52(4):490-5. doi: 10.1269/jrr.10189.
The aims of this study were to carry out a dose volume analysis of high-dose-rate interstitial brachytherapy with computed tomography-based treatment planning and to investigate the treatment outcome of patients with locally advanced bulky and/or irregularly shaped uterine cervical carcinoma. Between July 2003 and December 2007, 15 patients were treated with external beam radiation therapy and high-dose-rate interstitial brachytherapy with or without intracavitary brachytherapy. Seven patients were treated with interstitial brachytherapy alone, and 8 were treated with combined use of intracavitary and interstitial brachytherapy. A comparison of the volume and dose parameters with intracavitary and interstitial brachytherapy in patients who received both treatments showed that the median D90 of the high-risk clinical target volume per fraction was 4.4 Gy with intracavitary brachytherapy and 5.6 Gy with interstitial brachytherapy, and the median V100 was 66% with intracavitary brachytherapy and 85% with interstitial brachytherapy. The median D2cc of the bladder with intracavitary and interstitial brachytherapy per fraction was 5.5 Gy and 4.7 Gy, respectively, and the median D2cc of the rectum with intracavitary and interstitial brachytherapy was 5.9 Gy and 4.1 Gy, respectively. The median follow-up time was 37 months, and the overall and progression-free survival rates for all patients at 3 years were 78% and 51%, respectively. The actuarial 2-year and 3-year locoregional control rates were 80% and 71%, respectively. Dose distribution was improved with image-based interstitial brachytherapy, and satisfactory local control was achieved for patients with locally advanced uterine cervical carcinoma in which intracavitary brachytherapy may result in a suboptimal dose distribution.
本研究的目的是对基于 CT 的高剂量率组织间腔内近距离治疗进行剂量体积分析，并探讨局部晚期大块状和/或不规则形状子宫颈癌患者的治疗结果。2003 年 7 月至 2007 年 12 月，15 例患者接受外照射放疗和高剂量率组织间腔内近距离治疗，其中 7 例单独接受组织间腔内近距离治疗，8 例接受腔内和组织间近距离治疗联合治疗。对同时接受腔内和组织间近距离治疗的患者的剂量参数进行比较，结果显示：腔内近距离治疗的高危临床靶区（CTV）每分次的中位 D90 为 4.4 Gy，组织间腔内近距离治疗为 5.6 Gy；腔内近距离治疗的中位 V100 为 66%，组织间腔内近距离治疗为 85%。腔内和组织间近距离治疗时，膀胱的中位 D2cc 分别为 5.5 Gy 和 4.7 Gy，直肠的中位 D2cc 分别为 5.9 Gy 和 4.1 Gy。中位随访时间为 37 个月，所有患者 3 年的总生存率和无进展生存率分别为 78%和 51%。3 年局部区域控制率的累计发生率为 80%，2 年和 3 年的局部区域控制率分别为 71%和 65%。图像引导的组织间腔内近距离治疗改善了剂量分布，为局部晚期子宫颈癌患者实现了满意的局部控制，而腔内近距离治疗可能导致剂量分布不理想。
