Bahadur Yasir A, Eltaher Maha M, Hassouna Ashraf H, Attar Mohammad A, Constantinescu Camelia
Department of Radiology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
Department of Radiology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia ; Department of Radiation Oncology, National Cancer Institute, Cairo University, Egypt.
J Contemp Brachytherapy. 2015 Feb;7(1):41-7. doi: 10.5114/jcb.2015.48898. Epub 2015 Feb 4.
To retrospectively assess the incidence of sub-serosal and uterine perforation of intra-uterine tandem in intracavitary high-dose-rate (HDR) brachytherapy for cervical cancer, and to evaluate its dosimetric implications on computed tomography (CT)-based treatment planning.
Computed tomography images and brachytherapy plans of cervical cancer patients treated from February 2006 to December 2012 were reviewed for sub-optimal implants (sub-serosal and uterine perforation), and their correlation with cancer FIGO stage and patients' age. For each patient, the plans showing sub-optimal insertion of intra-uterine tandem were analyzed and compared to plans with adequate insertion. The difference in dose coverage of clinical-target-volume (CTV) and variation of the dose delivered to organs-at-risk (OARs) rectum and bladder were evaluated.
A total of 231 brachytherapy plans for 82 patients were reviewed. We identified 12 (14.6%) patients and 14 (6%) applications with uterine perforation, and 12 (14.6%) patients and 20 (8.6%) applications with sub-serosal insertion of tandem. Data analysis showed that advanced stage correlates with higher incidence of sub-optimal implants (p = 0.005) but not the age (p = 0.18). Dose-volume-histograms (DVHs) analysis showed large variations for CTV dose coverage: D90 significantly decreased with average of -115.7% ± 134.9% for uterine perforation and -65.2% ± 82.8% for sub-serosal insertion (p = 0.025). The rectum and bladder dose assessed by D2cc increased up to 70.3% and 43.8%, respectively, when sub-optimal insertion of uterine tandem occurred.
We report a low incidence of uterine perforation and sub-serosal insertion of uterine tandem in intracavitary HDR brachytherapy for cervical cancer. However, the effects on treatment plan dosimetry can be considerably detrimental. Therefore, we recommend image-guided insertion, at least for the challenging cases.
回顾性评估宫颈癌腔内高剂量率（HDR）近距离放射治疗中子宫内串联施源器浆膜下植入及子宫穿孔的发生率，并评估其对基于计算机断层扫描（CT）的治疗计划的剂量学影响。
回顾2006年2月至2012年12月接受治疗的宫颈癌患者的计算机断层扫描图像和近距离放射治疗计划，以查找植入不佳情况（浆膜下植入及子宫穿孔），并分析其与癌症国际妇产科联盟（FIGO）分期及患者年龄的相关性。对于每位患者，分析显示子宫内串联施源器植入不佳的计划，并与植入合适的计划进行比较。评估临床靶体积（CTV）剂量覆盖的差异以及直肠和膀胱等危及器官（OAR）所接受剂量的变化。
共回顾了82例患者的231份近距离放射治疗计划。我们识别出12例（14.6%）患者及14次（6%）应用存在子宫穿孔，12例（14.6%）患者及20次（8.6%）应用存在串联施源器浆膜下植入。数据分析表明，晚期与植入不佳的较高发生率相关（p = 0.005），但与年龄无关（p = 0.18）。剂量体积直方图（DVH）分析显示CTV剂量覆盖存在较大差异：子宫穿孔时D90显著降低，平均降低-115.7%±134.9%，浆膜下植入时降低-65.2%±82.8%（p = 0.025）。当子宫串联施源器植入不佳时，通过D2cc评估的直肠和膀胱剂量分别增加高达70.3%和43.8%。
我们报告了宫颈癌腔内HDR近距离放射治疗中子宫穿孔及子宫串联施源器浆膜下植入的发生率较低。然而，其对治疗计划剂量学的影响可能相当有害。因此，我们建议至少对于具有挑战性的病例采用图像引导下的植入。
