Department of Radiation Oncology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
Int J Radiat Oncol Biol Phys. 2012 Sep 1;84(1):137-45. doi: 10.1016/j.ijrobp.2011.10.066. Epub 2012 Jan 26.
To evaluate and compare the efficacy of medium-dose-rate (MDR) and low-dose-rate (LDR) intracavitary brachytherapy (ICBT) for uterine cervical cancer.
We evaluated 419 patients with squamous cell carcinoma of the cervix who were treated by radical radiotherapy with curative intent at Tokyo Women's Medical University from 1969 to 1999. LDR was used from 1969 to 1986, and MDR has been used since July 1987. When compared with LDR, fraction dose was decreased and fraction size was increased (1 or 2 fractions) for MDR to make the total dose of MDR equal to that of LDR. In general, the patients received a total dose of 60 to 70 Gy at Point A with external beam radiotherapy combined with brachytherapy according to the International Federation of Gynecology and Obstetrics stage. In the LDR group, 32 patients had Stage I disease, 81 had Stage II, 182 had Stage III, and 29 had Stage IVA; in the MDR group, 9 patients had Stage I disease, 19 had Stage II, 55 had Stage III, and 12 had Stage IVA.
The 5-year overall survival rates for Stages I, II, III, and IVA in the LDR group were 78%, 72%, 55%, and 34%, respectively. In the MDR group, the 5-year overall survival rates were 100%, 68%, 52%, and 42%, respectively. No significant statistical differences were seen between the two groups. The actuarial rates of late complications Grade 2 or greater at 5 years for the rectum, bladder, and small intestine in the LDR group were 11.1%, 5.8%, and 2.0%, respectively. The rates for the MDR group were 11.7%, 4.2%, and 2.6%, respectively, all of which were without statistical differences.
These data suggest that MDR ICBT is effective, useful, and equally as good as LDR ICBT in daytime (about 5 hours) treatments of patients with cervical cancer.
评估并比较中剂量率（MDR）和低剂量率（LDR）腔内近距离放疗（ICBT）治疗子宫颈癌的疗效。
我们评估了 1969 年至 1999 年期间在东京女子医科大学接受根治性放疗的 419 例宫颈鳞癌患者。1969 年至 1986 年使用 LDR，自 1987 年 7 月以来使用 MDR。与 LDR 相比，MDR 减少了分次剂量并增加了分次大小（1 或 2 次），以使 MDR 的总剂量与 LDR 相等。一般来说，根据国际妇产科联合会（FIGO）分期，患者在体外放疗联合近距离放疗时在 A 点接受 60-70Gy 的总剂量。在 LDR 组中，32 例为Ⅰ期疾病，81 例为Ⅱ期，182 例为Ⅲ期，29 例为ⅣA 期；在 MDR 组中，9 例为Ⅰ期疾病，19 例为Ⅱ期，55 例为Ⅲ期，12 例为ⅣA 期。
LDR 组Ⅰ、Ⅱ、Ⅲ和ⅣA 期的 5 年总生存率分别为 78%、72%、55%和 34%。MDR 组的 5 年总生存率分别为 100%、68%、52%和 42%。两组之间无显著统计学差异。LDR 组直肠、膀胱和小肠的 5 年晚期并发症≥2 级的累积发生率分别为 11.1%、5.8%和 2.0%。MDR 组分别为 11.7%、4.2%和 2.6%，均无统计学差异。
这些数据表明，MDR ICBT 在治疗宫颈癌患者时，在白天（约 5 小时）治疗中是有效、有用的，与 LDR ICBT 一样好。
