美国近距离放射治疗学会关于局部晚期宫颈癌的共识指南。第二部分：高剂量率近距离放射治疗。
American Brachytherapy Society consensus guidelines for locally advanced carcinoma of the cervix. Part II: high-dose-rate brachytherapy.
作者信息
Viswanathan Akila N, Beriwal Sushil, De Los Santos Jennifer F, Demanes D Jeffrey, Gaffney David, Hansen Jorgen, Jones Ellen, Kirisits Christian, Thomadsen Bruce, Erickson Beth
机构信息
Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA.
出版信息
Brachytherapy. 2012 Jan-Feb;11(1):47-52. doi: 10.1016/j.brachy.2011.07.002.
PURPOSE
This report presents an update to the American Brachytherapy Society (ABS) high-dose-rate (HDR) brachytherapy guidelines for locally advanced cervical cancer.
METHODS
Members of the ABS with expertise in cervical cancer formulated updated guidelines for HDR brachytherapy using tandem and ring, ovoids, cylinder, or interstitial applicators for locally advanced cervical cancer. These guidelines were written based on medical evidence in the literature and input of clinical experts in gynecologic brachytherapy.
RESULTS
The ABS affirms the essential curative role of tandem-based brachytherapy in the management of locally advanced cervical cancer. Proper applicator selection, insertion, and imaging are fundamental aspects of the procedure. Three-dimensional imaging with magnetic resonance or computed tomography or radiographic imaging may be used for treatment planning. Dosimetry must be performed after each insertion before treatment delivery. Applicator placement, dose specification, and dose fractionation must be documented, quality assurance measures must be performed, and followup information must be obtained. A variety of dose/fractionation schedules and methods for integrating brachytherapy with external-beam radiation exist. The recommended tumor dose in 2-Gray (Gy) per fraction radiobiologic equivalence (normalized therapy dose) is 80-90Gy, depending on tumor size at the time of brachytherapy. Dose limits for normal tissues are discussed.
CONCLUSION
These guidelines update those of 2000 and provide a comprehensive description of HDR cervical cancer brachytherapy in 2011.
目的
本报告介绍了美国近距离放射治疗学会（ABS）针对局部晚期宫颈癌的高剂量率（HDR）近距离放射治疗指南的更新内容。
方法
ABS中具有宫颈癌专业知识的成员制定了使用串联和环形、卵圆形、柱状或组织间施源器对局部晚期宫颈癌进行HDR近距离放射治疗的更新指南。这些指南基于文献中的医学证据以及妇科近距离放射治疗临床专家的意见编写而成。
结果
ABS肯定了基于串联的近距离放射治疗在局部晚期宫颈癌治疗中的关键治愈作用。正确选择施源器、插入施源器以及成像检查是该治疗过程的基本要素。可使用磁共振或计算机断层扫描三维成像或放射成像进行治疗计划制定。每次插入施源器后治疗前均须进行剂量测定。必须记录施源器放置位置、剂量设定及剂量分割情况，必须执行质量保证措施，并获取随访信息。存在多种剂量/分割方案以及将近距离放射治疗与外照射放疗相结合的方法。根据近距离放射治疗时肿瘤大小，每分次2戈瑞（Gy）放射生物学等效剂量（归一化治疗剂量）下推荐的肿瘤剂量为80 - 90Gy。文中讨论了正常组织的剂量限制。
结论
这些指南更新了2000年的指南，并在2011年对HDR宫颈癌近距离放射治疗进行了全面描述。
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