Viswanathan Akila N, Szymonifka Jackie, Tempany-Afdhal Clare M, O'Farrell Desmond A, Cormack Robert A
Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA 02115, USA.
Brachytherapy. 2013 May-Jun;12(3):240-7. doi: 10.1016/j.brachy.2012.08.006. Epub 2013 Feb 12.
To present outcome and toxicity results of the first real-time intraoperative MRI-guided interstitial approach to gynecologic cancer.
From February 2004 to December 2006, 25 patients with gynecologic malignancies were enrolled and treated in a prospective clinical trial of real-time MRI-guided interstitial brachytherapy. This was followed by a confirmatory CT imaging scan. Statistical analyses included Kaplan-Meier estimates for overall and relapse-free survival.
MRI visualization of needles during placement permitted accurate placement with no inadvertent insertions. This prevented unnecessary normal-tissue perforation as confirmed by CT simulation. With a mean followup of 3.8 years (range, 2-6.8), 1-, 2-, and 3-year overall survival rates were 80%, 60% and 43%, respectively; corresponding relapse-free survival rates were 79%, 65%, and 59%, respectively. Actuarial acute toxicity rates for any grade were 0% at 0-14 days and 80% (all grade 1) at 14-90 days. Long-term (>180 days) actuarial toxicity rates were 8% gastrointestinal, 4% bladder and 4% vaginal.
Real-time MRI guidance during insertion of interstitial needles followed by 3D-planning maximized opportunities for tumor targeting and sparing of normal tissues. Although image guidance requires additional anesthesia time, clinical outcomes indicate potential for a successful reduction in toxicity using 3D image-guided in addition to 3D image-planned brachytherapy.
介绍首例实时术中磁共振成像引导的妇科癌症间质治疗方法的治疗效果和毒性结果。
2004年2月至2006年12月，25例妇科恶性肿瘤患者参加了一项实时磁共振成像引导的间质近距离放射治疗前瞻性临床试验。随后进行了CT成像扫描以进行确认。统计分析包括总体生存率和无复发生存率的Kaplan-Meier估计。
放置针时磁共振成像可视化可实现精确放置，无意外插入。CT模拟证实这可防止不必要的正常组织穿孔。平均随访3.8年（范围2至6.8年），1年、2年和3年的总生存率分别为80%、60%和43%；相应的无复发生存率分别为79%、65%和59%。0至14天任何级别的急性毒性发生率为0%，14至90天为80%（均为1级）。长期（>180天）毒性发生率为胃肠道8%、膀胱4%和阴道4%。
间质针插入过程中进行实时磁共振成像引导并结合三维规划，可最大限度地增加肿瘤靶向和正常组织保护的机会。尽管图像引导需要额外的麻醉时间，但临床结果表明，除了三维图像规划的近距离放射治疗外，使用三维图像引导有可能成功降低毒性。
