Vanneste Ben G L, Meijnen Philip, Hammerstein Chris S J, Bijker Nina, van Os Rob M, Stalpers Lukas J A, Pieters Bradley R
Department of Radiation Oncology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands; Department of Radiation Oncology, MAASTRO Clinic, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands.
Department of Radiation Oncology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands; Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
Brachytherapy. 2015 Mar-Apr;14(2):273-8. doi: 10.1016/j.brachy.2014.10.002. Epub 2014 Nov 20.
To evaluate the rate of vaginal, pelvic, and distant failures and acute toxicity after postoperative vaginal vault brachytherapy (VBT) delivered by a ring applicator in women with high intermediate-risk endometrial cancer.
A total of 100 patients were treated with VBT after a total abdominal hysterectomy and bilateral salpingo-oophorectomy for a Stage IA or IB (International Federation of Gynecology and Obstetrics 2009) intermediate-risk endometrial cancer; 26 patients received 30-Gy low-dose-rate, 74 patients received 28-Gy pulsed-dose-rate brachytherapy.
At a median followup of 37 months (range, 1-107), 6 (6%) patients showed failures. Three patients developed an in-field recurrence in the vaginal vault: 1 was isolate, whereas the other 2 showed simultaneous pelvic and/or distant failure. A fourth patient developed an out-of-field recurrence in the posterior vaginal wall of the proximal half of the vagina, including pelvic and distant failure. Two other patients showed only distant failure. The estimated 3-year actuarial rate of any vaginal recurrence was 2.6% (95% confidence interval, 0-6.3%). The 5-year overall survival was 84%, similar to that in the female Dutch population matched for age and date of diagnosis. The acute side effects were low, consisting mainly of the occurrence of temporary diarrhea (2%).
Postoperative VBT by a ring applicator results in a low recurrence risk, survival rates comparable with the normal female population, and a very low risk of acute morbidity.
评估采用环形施源器对高中危子宫内膜癌患者进行术后阴道穹窿近距离放疗（VBT）后的阴道、盆腔和远处复发率以及急性毒性反应。
共有100例患者在接受全腹子宫切除术和双侧输卵管卵巢切除术后，因IA期或IB期（国际妇产科联盟2009年分期）中危子宫内膜癌接受VBT治疗；26例患者接受30 Gy的低剂量率放疗，74例患者接受28 Gy的脉冲剂量率近距离放疗。
中位随访37个月（范围1 - 107个月）时，6例（6%）患者出现复发。3例患者在阴道穹窿出现野内复发：1例为孤立复发，另外2例同时出现盆腔和/或远处复发。第4例患者在阴道近端后壁出现野外复发，包括盆腔和远处复发。另外2例患者仅出现远处复发。估计3年任何阴道复发的精算率为2.6%（95%置信区间，0 - 6.3%）。5年总生存率为84%，与年龄和诊断日期匹配的荷兰女性人群相似。急性副作用较低，主要为出现短暂腹泻（2%）。
采用环形施源器进行术后VBT导致复发风险低，生存率与正常女性人群相当，且急性发病风险极低。
