Bacorro Warren, Dumas Isabelle, Levy Antonin, Rivin Del Campo Eleonor, Canova Charles-Henri, Felefly Tony, Huertas Andres, Marsolat Fanny, Haie-Meder Christine, Chargari Cyrus, Mazeron Renaud
Department of Radiation Oncology, Brachytherapy Unit, Gustave Roussy, University of Paris Saclay, Villejuif, France; Department of Radiation Oncology, Benavides Cancer Institute, University of Santo Tomas Hospital, Manila, Philippines.
Department of Medical Physics, Gustave Roussy, University of Paris Saclay, Villejuif, France.
Brachytherapy. 2017 Mar-Apr;16(2):366-372. doi: 10.1016/j.brachy.2016.11.016. Epub 2017 Jan 31.
With the increasing use of simultaneous integrated boost in the treatment of cervical cancer, there is a need to anticipate the brachytherapy (BT) contribution at the level of the pathologic pelvic lymph nodes. This study aimed to report the dose delivered at their level during BT.
Patients with pelvic nodal involvement and treated with a combination of chemoradiation followed by image-guided adaptive pulsed-dose-rate BT were selected. On per BT three-dimensional images, pelvic lymphadenopathies were delineated, without planning aim. For the purposes of the study, D, D, D, and D were reviewed and converted in 2-Gy equivalent doses, using the linear quadratic model with an α/β of 10 Gy.
Ninety-one patients were identified, allowing evaluation at the level of 226 lymphadenopathies. The majority of them were external iliac (48%), followed by common iliac (25%), and internal iliac (16%) regions. The 2-Gy equivalent doses D were 4.4 ± 1.9 Gy, 5.4 ± 3.1 Gy, and 4.3 ± 2.1 Gy for the obturator, internal iliac, and external iliac, respectively, and 2.8 ± 2.5 Gy for the common iliac. The contribution to the common iliac nodes was significantly lower than the one of external and internal iliac (p < 0.001).
BT significantly contributes to the treatment of pelvic nodes at the level of approximately 5 Gy in the internal, external, and obturator areas and 2.5 Gy in the common iliac, allowing the anticipation of nodal boost with the simultaneous integrated boost technique. However, important individual variations have been observed, and evaluation of the genuine BT contribution should be recommended.
随着同步整合加量在宫颈癌治疗中的应用日益增加，有必要预测近距离放射治疗（BT）对盆腔病理淋巴结的剂量贡献。本研究旨在报告BT期间盆腔淋巴结所接受的剂量。
选取有盆腔淋巴结受累且接受了放化疗联合图像引导下适应性脉冲剂量率BT治疗的患者。在每次BT的三维图像上，勾画盆腔淋巴结病变，不设计划靶区。为进行本研究，回顾了D、D、D和D，并使用α/β为10 Gy的线性二次模型将其转换为2 Gy等效剂量。
共纳入91例患者，可对226个淋巴结病变进行评估。其中大多数位于髂外淋巴结（48%），其次是髂总淋巴结（25%）和髂内淋巴结（16%）。闭孔、髂内、髂外淋巴结的2 Gy等效剂量D分别为4.4±1.9 Gy、5.4±3.1 Gy和4.3±2.1 Gy，髂总淋巴结为2.8±2.5 Gy。髂总淋巴结的剂量贡献显著低于髂外和髂内淋巴结（p<0.001）。
BT对盆腔淋巴结的治疗有显著贡献，在内侧、外侧和闭孔区域剂量约为5 Gy，在髂总淋巴结区域为2.5 Gy，这使得采用同步整合加量技术时能够预测淋巴结加量。然而，可以观察到明显的个体差异，因此建议评估BT的实际贡献。
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