Chatani Masashi, Tsuboi Kazuki, Yagi Masayuki, Fujiwara Kanta, Tachimoto Rika
Department of Radiation Oncology, Osaka Rosai Hospital, 1179-3 Nagasone-cyo, kita-ku, Sakai, Osaka, Japan
Department of Radiation Oncology, Osaka Rosai Hospital, 1179-3 Nagasone-cyo, kita-ku, Sakai, Osaka, Japan.
J Radiat Res. 2014 Jul;55(4):748-53. doi: 10.1093/jrr/rrt226. Epub 2014 Feb 20.
We compared the survival rates and late effects for two groups of cervical cancer patients treated with almost the same external radiotherapy but different remote afterloading systems (RALS) for high-dose-rate intracavitary radiation therapy regimens. A total of 218 patients with carcinoma of the uterine cervix were treated. For 98 patients, intracavitary brachytherapy was delivered with 6-7.5 Gy/fraction to Point A (Group A), and for 120, 5 Gy/fraction with a modified source step size (Group B). The 3-year cause-specific survival rates by stage and treatment schedule were Group A: 91% and Group B: 96% in Stage I, 89% and 92% in Stage II, 64% and 75% in Stage III, 44% and 69% in Stage IV. The survival curves did not reveal any statistically significant differences at any stage. The 3-year cumulative local failure rates were 14% in Group A and 7% in Group B (P = 0.1202), while the actuarial rates of developing rectal complication (Grade 2 or more) at 3 years were 25% in Group A and 4% in Group B (P < 0.0001). This retrospective analysis suggests that a low dose per fraction with modified source step size is advantageous because of yielding almost the same local control but with fewer rectal complications.
我们比较了两组宫颈癌患者的生存率和远期效应，这两组患者接受了几乎相同的体外放射治疗，但在高剂量率腔内放射治疗方案中使用了不同的后装系统（RALS）。共有218例子宫颈癌患者接受了治疗。98例患者腔内近距离放疗时，A点剂量为6 - 7.5 Gy/分次（A组），120例患者腔内近距离放疗时，采用改良源步长，剂量为5 Gy/分次（B组）。按分期和治疗方案计算的3年病因特异性生存率为：I期，A组91%，B组96%；II期，A组89%，B组92%；III期，A组64%，B组75%；IV期，A组44%，B组69%。生存曲线在任何分期均未显示出任何统计学上的显著差异。3年累积局部失败率A组为14%，B组为7%（P = 0.1202），而3年发生直肠并发症（2级或更高级别）的精算率A组为25%，B组为4%（P < 0.0001）。这项回顾性分析表明，采用改良源步长的低分次剂量是有利的，因为它能产生几乎相同的局部控制效果，但直肠并发症较少。
