Kishan Amar U, Lee Edward W, McWilliams Justin, Lu David, Genshaft Scott, Motamedi Kambiz, Demanes D Jeffrey, Park Sang June, Hagio Mary Ann, Wang Pin-Chieh, Kamrava Mitchell
Department of Radiation Oncology.
Department of Interventional Radiology, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
J Contemp Brachytherapy. 2015 Oct;7(5):327-35. doi: 10.5114/jcb.2015.54947. Epub 2015 Oct 13.
To determine the ability of image-guided high-dose-rate brachytherapy (IG-HDR) to provide local control (LC) of lesions in non-traditional locations for patients with heavily pre-treated malignancies.
This retrospective series included 18 patients treated between 2012 and 2014 with IG-HDR, either in combination with external beam radiotherapy (EBRT; n = 9) or as monotherapy (n = 9). Lesions were located in the pelvis (n = 5), extremity (n = 2), abdomen/retroperitoneum (n = 9), and head/neck (n = 2). All cases were performed in conjunction between interventional radiology and radiation oncology. Toxicity was graded based on CTCAE v4.0 and local failure was determined by RECIST criteria. Kaplan-Meier analysis was performed for LC and overall survival.
The median follow-up was 11.9 months. Two patients had localized disease at presentation; the remainder had recurrent and/or metastatic disease. Seven patients had prior EBRT, with a median equivalent dose in 2 Gy fractions (EQD2) of 47.0 Gy. The median total EQD2s were 34 Gy and 60.9 Gy for patients treated with monotherapy or combination therapy, respectively. Image-guided high-dose rate brachytherapy was delivered in one to six fractions. Six patients had local failures at a median interval of 5.27 months with a one-year LC rate of 59.3% and a one-year overall survival of 40.7%. Six patients died from their disease at a median interval of 6.85 months from the end of treatment. There were no grade ≥ 3 acute toxicities but two patients had serious long term toxicities.
We demonstrate a good one year LC rate of nearly 60%, and a favorable toxicity profile when utilizing IG-HDR to deliver high doses of radiation with high precision into targets not readily accessible by other forms of local therapy. These preliminary results suggest that further studies utilizing this approach may be considered for patients with difficult to access lesions that require LC.
确定图像引导下的高剂量率近距离放射治疗（IG-HDR）对经过大量前期治疗的恶性肿瘤患者非传统部位病变提供局部控制（LC）的能力。
本回顾性系列研究纳入了2012年至2014年间接受IG-HDR治疗的18例患者，其中9例联合外照射放疗（EBRT），9例为单纯治疗。病变位于骨盆（5例）、四肢（2例）、腹部/腹膜后（9例）和头颈部（2例）。所有病例均由介入放射学和放射肿瘤学联合进行。毒性根据CTCAE v4.0分级，局部失败根据RECIST标准确定。对局部控制率和总生存率进行了Kaplan-Meier分析。
中位随访时间为11.9个月。2例患者初诊时为局限性疾病；其余患者为复发和/或转移性疾病。7例患者曾接受过EBRT，2 Gy等效剂量（EQD2）的中位剂量为47.0 Gy。单纯治疗或联合治疗患者的总EQD2中位剂量分别为34 Gy和60.9 Gy。图像引导下的高剂量率近距离放射治疗分1至6次进行。6例患者出现局部失败，中位间隔时间为5.27个月，一年局部控制率为59.3%，一年总生存率为40.7%。6例患者死于疾病，中位间隔时间为治疗结束后6.85个月。无≥3级急性毒性反应，但有2例患者出现严重的长期毒性反应。
我们证明了近60%的良好一年局部控制率，以及在利用IG-HDR将高剂量辐射高精度地输送到其他局部治疗难以到达的靶区时具有良好的毒性特征。这些初步结果表明，对于需要局部控制的难以到达的病变患者，可以考虑进一步开展利用这种方法的研究。
