Sharma Daya Nand, Gandhi Ajeet Kumar, Bhatla Neerja, Kumar Sunesh, Rath Goura Kisor
Department of Radiation Oncology.
Gynecology and Obstetrics, All India Institute of Medical Sciences, New Delhi, India.
J Contemp Brachytherapy. 2016 Feb;8(1):41-7. doi: 10.5114/jcb.2016.57461. Epub 2016 Jan 27.
Peri-urethral cancer (PUC) in females is a rare malignancy. Surgery is not usually contemplated due to associated morbidity. Radiation therapy (RT) can be employed in the form of interstitial brachytherapy (IBT) alone for early lesions, and external beam radiation therapy (EBRT) with or without IBT for advanced lesions. We report our first experience in the literature to evaluate the role of high-dose-rate (HDR) IBT in female PUC.
Between 2008 and 2013, 10 female patients with PUC (5 primary and 5 recurrent) were treated with HDR-IBT with or without EBRT at our center. Size of the lesion ranged from 1.5 cm to 5.0 cm. A 2-3 plane free-hand implant was performed using plastic catheters. The prescribed dose of HDR-IBT was 42 Gy in 14 fractions for brachytherapy alone (5 patients), and 18-21 Gy for the boost along with EBRT (5 patients). Patients were followed up regularly for assessment of disease control and toxicity.
At a median follow up of 25 months, six patients were disease free at their last follow up. Four patients developed recurrence: 2 at inguinal nodes, 1 at local site, and 1 at both local as well as inguinal nodes. Moist desquamation was the commonest acute toxicity observed in all 5 patients treated with IBT alone, which healed within 4 weeks' time. Overall, grade II delayed complication rate was 30%.
Though small sample size, the results of our study have shown that HDR-IBT provides good loco-regional control with acceptable toxicity for female PUC.
女性尿道周围癌（PUC）是一种罕见的恶性肿瘤。由于相关的发病率，通常不考虑手术治疗。放射治疗（RT）可单独采用组织间近距离放射治疗（IBT）的形式用于早期病变，对于晚期病变则采用外照射放疗（EBRT）联合或不联合IBT。我们报告了文献中首例评估高剂量率（HDR）IBT在女性PUC中作用的经验。
2008年至2013年期间，我们中心对10例女性PUC患者（5例原发性和5例复发性）进行了HDR-IBT联合或不联合EBRT治疗。病变大小从1.5厘米到5.0厘米不等。使用塑料导管进行2-3平面徒手植入。单纯近距离放射治疗（5例患者）的HDR-IBT规定剂量为42 Gy，分14次给予，联合EBRT进行增敏照射时的剂量为18-21 Gy（5例患者）。定期对患者进行随访，以评估疾病控制情况和毒性。
中位随访25个月时，6例患者在最后一次随访时无疾病复发。4例患者出现复发：2例在腹股沟淋巴结，1例在局部部位，1例在局部及腹股沟淋巴结均有复发。在仅接受IBT治疗的所有5例患者中，湿性脱皮是最常见的急性毒性反应，在4周内愈合。总体而言，II级延迟并发症发生率为30%。
尽管样本量较小，但我们的研究结果表明，HDR-IBT对女性PUC具有良好的局部区域控制效果，且毒性可接受。
