Nout R A, Devic S, Niazi T, Wyse J, Boutros M, Pelsser V, Vuong T
Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Radiation Oncology, Jewish General Hospital, McGill University, Montréal, Québec, Canada; Medical Physics Unit, McGill University, Montréal, Québec, Canada.
Brachytherapy. 2016 Jul-Aug;15(4):477-484. doi: 10.1016/j.brachy.2016.03.004. Epub 2016 Apr 16.
During the last decade due to the availability of a CT scan in the brachytherapy suite, high-dose-rate endorectal brachytherapy (HDREBT) has evolved as a CT-based daily adaptive treatment. An update of the technical and practical aspects of HDREBT is provided.
Description of technical and practical aspects of HDREBT focused on the preoperative treatment of locally advanced rectal cancer. During preoperative HDREBT, 26 Gy is delivered in four daily applications of 6.5 Gy prescribed to the 100% isodose, covering the clinical target volume. Daily CT scans are obtained and used for plan optimization, leaving patient positioning unchanged between CT scan and treatment delivery.
All steps of HDREBT treatment procedure are discussed in detail: flexible proctosigmoidoscopy and clipping; patient setup; applicator placement; target delineation; treatment planning and delivery; and patient care. Afterward, treatment results are reviewed.
CT-based adaptive preoperative HDREBT is a practical and feasible therapy for locally advanced rectal cancer, offering excellent local control with a favorable toxicity profile.
在过去十年中，由于近距离放射治疗套房中可使用CT扫描，高剂量率直肠内近距离放射治疗（HDREBT）已发展成为一种基于CT的每日适应性治疗方法。本文提供了HDREBT技术和实践方面的最新情况。
HDREBT技术和实践方面的描述重点在于局部晚期直肠癌的术前治疗。在术前HDREBT期间，以每日4次、每次6.5 Gy的剂量给予26 Gy，处方剂量为100%等剂量线，覆盖临床靶区。每天进行CT扫描并用于计划优化，在CT扫描和治疗实施之间患者体位保持不变。
详细讨论了HDREBT治疗过程的所有步骤：柔性直肠乙状结肠镜检查和夹闭；患者摆位；施源器放置；靶区勾画；治疗计划和实施；以及患者护理。之后，回顾了治疗结果。
基于CT的适应性术前HDREBT是一种治疗局部晚期直肠癌的实用且可行的方法，能提供良好的局部控制且毒性反应较轻。
