Tharavichitkul Ekkasit, Wanwilairat Somsak, Chakrabandhu Somvilai, Klunklin Pitchayaponne, Onchan Wimrak, Tippanya Damrongsak, Nopnop Wannapa, Galalae Razvan, Chitapanarux Imjai
The Division of Therapeutic Radiology and Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
J Contemp Brachytherapy. 2013 Mar;5(1):10-6. doi: 10.5114/jcb.2013.34338. Epub 2013 Mar 29.
A report of preliminary results and toxicity profiles using image-guided brachytherapy (IGBT) combined with whole pelvic intensity-modulated radiation therapy (WP-IMRT) for locally advanced cervical cancer.
Fifteen patients with locally advanced cervical cancer were enrolled into the study. WP-IMRT was used to treat the Clinical Target Volume (CTV) with a dose of 45 Gy in 25 fractions. Concurrent cisplatin (40 mg/m(2)) was prescribed during radiotherapy (RT) on weekly basis. IGBT using computed tomography was performed at the dose of 7 Gy × 4 fractions to the High-Risk Clinical Target Volume (HR-CTV).
The mean cumulative doses - in terms of equivalent dose of 2 Gy (EQD2) - of IGBT plus WP-IMRT to HR-CTV, bladder, rectum, and sigmoid colon were 88.3, 85.0, 68.2 and 73.6 Gy, respectively. In comparison with standard (point A prescription) dose-volume histograms, volume-based image-guided brachytherapy improved the cumulative doses for bladder of 67%, rectum of 47% and sigmoid of 46%. At the median follow-up time of 14 months, the local control, metastasis-free survival and overall survival rates were 93%, 100% and 93%, respectively. No grade 3-4 acute and late toxicities were observed.
The combination of image-guided brachytherapy and intensity-modulated radiotherapy improved the dose distribution to tumor volumes and avoided overdose in OARs which could be converted in excellent local control and toxicity profiles.
报告图像引导近距离放射治疗（IGBT）联合全盆腔调强放射治疗（WP-IMRT）用于局部晚期宫颈癌的初步结果和毒性特征。
15例局部晚期宫颈癌患者纳入本研究。采用WP-IMRT治疗临床靶区（CTV），剂量为45 Gy，分25次给予。在放疗期间每周给予顺铂（40 mg/m²）同步化疗。采用计算机断层扫描引导的IGBT对高危临床靶区（HR-CTV）给予7 Gy×4次的剂量。
IGBT联合WP-IMRT给予HR-CTV、膀胱、直肠和乙状结肠的平均累积剂量（以2 Gy等效剂量计，EQD2）分别为88.3、85.0、68.2和73.6 Gy。与标准（A点处方）剂量体积直方图相比，基于体积的图像引导近距离放射治疗使膀胱累积剂量提高了67%，直肠提高了47%，乙状结肠提高了46%。中位随访时间为14个月时，局部控制率、无转移生存率和总生存率分别为93%、100%和93%。未观察到3-4级急性和晚期毒性反应。
图像引导近距离放射治疗与调强放射治疗相结合改善了肿瘤靶区的剂量分布，避免了危及器官的过量照射，可实现良好的局部控制和毒性特征。
