Gupta Phalguni, Aich Ranen Kanti, Deb Asit Ranjan
Department of Radiotherapy, Nil Ratan Sirkar Medical College & Hospital, Kolkata.
Department of Radiotherapy, Medical College Hospital, Kolkata, West Bengal, India.
J Contemp Brachytherapy. 2014 Oct;6(3):276-81. doi: 10.5114/jcb.2014.45493. Epub 2014 Sep 23.
Almost 30% of malignancies in women of developing countries are gynecological and brachytherapy is an integral part of management of these patients. Reports of complications (both acute and late) of high-dose-rate (HDR) intracavitary brachytherapy are sparse in world literature due to relatively small number of gynecological malignancies, particularly in advanced stage, in developed countries. High-dose-rate brachytherapy is gaining popularity in developing countries due to scientific and economic reasons. Here we are reporting our experience regarding acute complications of intracavitary brachytherapy (events occurring within 30 days of insertion needing hospitalization or death) and their causes to improve the quality of management, so that the already low incidence of acute complications can be further reduced.
From February 2004 to December 2012, a total of 1947 patients with uterine cancer were treated by HDR intracavitary brachytherapy in the Department of Radiotherapy, of a tertiary cancer centre of a developing country, 86% of them were cervical cancer and 14% endometrial cancer. Excluding the post-operative patients, a total of 4285 insertions were done in 1527 patients with intact uterus (eligible for analysis) and acute complications were analyzed.
Out of 4285 intracavitary brachytherapy insertions in gynecological malignancy patients, only 12 mortality and 239 morbidity instances needing hospitalization were documented and most of them were in cervical carcinoma patients.
Our results have indicated that acute complications can be minimized by pre-treatment management of co-morbidities, decreasing the time of operative lithotomy position and bed rest, avoidance of 'conscious sedation' in selected cases etc. Routine post insertion CT scan if done in all patients in all insertions, then only, uterine perforations can be detected early and prompt management can reduce both the mortality and morbidity to a great extent.
在发展中国家，近30%的女性恶性肿瘤为妇科肿瘤，近距离放射治疗是这些患者治疗的重要组成部分。由于发达国家妇科恶性肿瘤数量相对较少，尤其是晚期病例，因此世界文献中关于高剂量率（HDR）腔内近距离放射治疗并发症（包括急性和晚期）的报道较为稀少。由于科学和经济原因，高剂量率近距离放射治疗在发展中国家越来越受欢迎。在此，我们报告我们关于腔内近距离放射治疗急性并发症（插入后30天内发生的需要住院或死亡的事件）及其原因的经验，以提高管理质量，从而进一步降低本就较低的急性并发症发生率。
2004年2月至2012年12月，在一个发展中国家的三级癌症中心的放射治疗科，共有1947例子宫癌患者接受了HDR腔内近距离放射治疗，其中86%为宫颈癌，14%为子宫内膜癌。排除术后患者，对1527例子宫完整的患者（符合分析条件）进行了共计4285次插入操作，并对急性并发症进行了分析。
在4285次妇科恶性肿瘤患者的腔内近距离放射治疗插入操作中，仅记录到12例死亡和239例需要住院治疗的发病情况，其中大多数发生在宫颈癌患者中。
我们的结果表明，通过对合并症进行预处理、缩短手术截石位时间和卧床休息时间、在部分病例中避免“清醒镇静”等措施，可以将急性并发症降至最低。如果对所有患者的所有插入操作都进行常规插入后CT扫描，那么只有这样才能早期发现子宫穿孔，并通过及时处理在很大程度上降低死亡率和发病率。
