Llewelyn Megan, Taylor Alexandra
Department of Gynaecology, Royal Marsden Hospital, London, UK.
Curr Opin Oncol. 2017 Sep;29(5):343-350. doi: 10.1097/CCO.0000000000000392.
Re-irradiation historically has been associated with unacceptable toxicity and limited benefit. Recent advances in radiotherapy can change the treatment paradigm to provide new salvage treatments for recurrences of cervical and endometrial cancer.
Image-guided brachytherapy is an effective method for salvaging central pelvic recurrence, although it has resulted in 20-25% severe late toxicity. Pelvic sidewall disease is not accessible to brachytherapy, so a combined modality approach with radical surgery and intraoperative radiotherapy is an alternative approach. Stereotactic body radiotherapy (SBRT) now provides the option of radical re-irradiation with local control rates of 50-80% and a low incidence of severe late complications.
Initial outcomes using SBRT and image-guided brachytherapy for re-irradiation of gynaecological cancer are encouraging. There has been good local control and acceptable toxicity. Further, large-scale studies are required to define optimal target doses and OAR limits.
既往再程放疗一直与不可接受的毒性及有限的获益相关。放射治疗的近期进展可改变治疗模式，为宫颈癌和子宫内膜癌复发提供新的挽救性治疗方法。
图像引导近距离放疗是挽救盆腔中央复发的有效方法，尽管会导致20%-25%的严重晚期毒性。近距离放疗无法用于治疗盆腔侧壁疾病，因此联合根治性手术和术中放疗是一种替代方法。立体定向体部放疗（SBRT）现在提供了根治性再程放疗的选择，局部控制率为50%-80%，严重晚期并发症发生率低。
使用SBRT和图像引导近距离放疗对妇科癌症进行再程放疗取得的初步结果令人鼓舞。局部控制良好且毒性可接受。此外，需要大规模研究来确定最佳靶区剂量和危及器官限量。
