Department of Oncology, Aarhus University Hospital, Denmark.
Radiother Oncol. 2011 Sep;100(3):473-9. doi: 10.1016/j.radonc.2011.08.016. Epub 2011 Sep 15.
To retrospectively assess treatment outcome of image and laparoscopic guided interstitial pulsed dose rate brachytherapy (PDR-BT) for locally advanced gynaecological cancer using the adaptive GEC ESTRO target concept.
Between June 2005 and December 2010, 28 consecutive patients were treated for locally advanced primary vaginal (nine), recurrent endometrial (12) or recurrent cervical cancer (seven) with combined external beam radiotherapy (EBRT) and interstitial PDR-BT. Treatment was initiated with whole pelvic EBRT to a median dose of 45 Gy followed by PDR-BT using the Martinez Universal Perineal Interstitial Template (MUPIT). All implants were virtually preplanned using MRI of the pelvis with a dummy MUPIT in situ. The GEC ESTRO high risk clinical target volume (HR CTV), intermediate risk clinical target volume (IR CTV) and the organs at risk (OAR) were contoured and a preplan for implantation was generated (BrachyVision, Varian). The subsequent implantation was performed under laparoscopic visualisation. Final contouring and treatment planning were done using a post-implant CT. Planning aim of PDR-BT was to deliver 30 Gy in 50 hourly pulses to HR CTV. Manual dose optimisation was performed with the aim of reaching a D90>80 Gy in the HR CTV calculated as the total biologically equivalent to 2 Gy fractions of EBRT and BT (EQD2). Dose to the OAR were evaluated using dose volume constraints for D(2cc) of 90 Gy for bladder and 70 Gy for rectum and sigmoid.
For HR CTV the median volume was 26 cm(3) (7-91 cm(3)). Coverage of the HR CTV was 97% (90-100%) and D90 was 82 Gy (77-88 Gy). The D(2cc) for bladder, rectum, and sigmoid were 65 Gy (47-81 Gy), 61 Gy (50-77 Gy), and 52 Gy (44-68 Gy), respectively. Median follow up was 18 months (6-61 months). The actuarial 2 years local control rate was 92% (SE 5), while disease-free survival and overall survival were 59% (SE 11) and 74%, respectively (SE 10). No complications to the laparoscopic guided implantation were encountered. Late grade 2 (CTC v 3.0) complications were recorded in nine (32%) patients. One patient had a grade 3 vaginal complication. No grade 4-5 complications have been recorded so far.
Image and laparoscopic guided interstitial PDR-BT using the GEC ESTRO target concept is applicable for locally advanced primary vaginal or recurrent endometrial and cervical cancer resulting in an excellent local control rate and limited morbidity.
回顾性评估使用自适应 GEC ESTRO 靶区概念的图像和腹腔镜引导的间质脉冲剂量率近距离放射治疗（PDR-BT）治疗局部晚期妇科癌症的治疗效果。
2005 年 6 月至 2010 年 12 月，28 例局部晚期原发性阴道癌（9 例）、复发性子宫内膜癌（12 例）或复发性宫颈癌（7 例）患者接受了联合外部束放疗（EBRT）和间质 PDR-BT 治疗。采用全盆腔 EBRT 起始治疗，中位剂量 45 Gy，然后采用 Martinez 通用会阴间质模板（MUPIT）进行 PDR-BT。所有植入物均通过骨盆 MRI 进行虚拟预规划，使用原位假 MUPIT。勾画 GEC ESTRO 高危临床靶区（HR CTV）、中危临床靶区（IR CTV）和危及器官（OAR），生成植入物预规划（BrachyVision，Varian）。随后在腹腔镜可视化下进行植入。使用植入后 CT 进行最终轮廓和治疗计划。PDR-BT 的计划目标是向 HR CTV 递送 30 Gy，共 50 个小时脉冲，剂量率为 6 Gy/h。手动剂量优化的目的是使 HR CTV 中的 D90>80 Gy，D90 计算为 EBRT 和 BT（EQD2）的总生物等效 2 Gy 分数。使用膀胱 D2cc<90 Gy 和直肠、乙状结肠 D2cc<70 Gy 的剂量体积限制评估 OAR 剂量。
HR CTV 的中位体积为 26 cm3（7-91 cm3）。HR CTV 的覆盖率为 97%（90-100%），D90 为 82 Gy（77-88 Gy）。膀胱、直肠和乙状结肠的 D2cc 分别为 65 Gy（47-81 Gy）、61 Gy（50-77 Gy）和 52 Gy（44-68 Gy）。中位随访时间为 18 个月（6-61 个月）。2 年局部控制率的 actuarial 为 92%（SE 5），而无病生存率和总生存率分别为 59%（SE 11）和 74%（SE 10）。未发生与腹腔镜引导植入相关的并发症。9 例（32%）患者出现晚期 2 级（CTC v 3.0）并发症。1 例患者出现 3 级阴道并发症。目前尚未记录到 4-5 级并发症。
使用 GEC ESTRO 靶区概念的图像和腹腔镜引导的间质 PDR-BT 适用于局部晚期原发性阴道癌或复发性子宫内膜癌和宫颈癌，可获得优异的局部控制率和较低的发病率。
