Jordan Scott E, Micaily Ida, Hernandez Enrique, Ferriss J Stuart, Miyamoto Curtis T, Li Shidong, Micaily Bizhan
Temple Health Fox Chase Cancer Center Department of Gynecologic Oncology, Philadelphia, PA.
Abington Jefferson Health Department of Internal Medicine, Abington, PA.
Brachytherapy. 2017 Nov-Dec;16(6):1144-1151. doi: 10.1016/j.brachy.2017.08.006. Epub 2017 Sep 22.
The purpose of this case series is to describe the treatment and outcomes of a cohort of patients with inoperable early-stage endometrioid endometrial cancer with 3D image-guided high-dose-rate (HDR) intracavitary brachytherapy.
A review was performed of patients with early-stage endometrial cancer who underwent primary radiation treatment between 2010 and 2016. Staging and treatment planning were performed CT, pelvic ultrasound, and pelvic MRI. Gross tumor volume (GTV) was defined as the MRI or ultrasound demonstrated endometrial stripe width, with the entire uterine corpus, cervix, and proximal vagina representing the clinical target volume (CTV). Dosimetry calculations were performed in each fraction of HDR brachytherapy.
Eight patients received external beam radiation therapy followed by intracavitary HDR brachytherapy. Seven patients underwent intracavitary HDR brachytherapy alone. In all patients, mean cumulative dose to 90% (D) of GTV was 95.99 Gy in equivalent dose in 2 Gy fractions (EQD, α/β = 10). Mean cumulative D EQD to CTV was 51.64 Gy. Average follow-up was 29 months. Four patients died from concurrent disease(s) at an average of 2.83 years after completion of treatment. Except for 1 (6.6%) patient who recurred at 9 months following completion of treatment, all patients remained disease-free for the remainder of follow-up.
In patients who are poor surgical candidates and have early-stage endometrioid type endometrial carcinoma, image-guided HDR intracavitary brachytherapy carries minimal side effects and a high response rate.
本病例系列的目的是描述一组无法手术的早期子宫内膜样子宫内膜癌患者接受三维图像引导高剂量率（HDR）腔内近距离放射治疗的治疗情况及结果。
对2010年至2016年间接受初次放射治疗的早期子宫内膜癌患者进行回顾性研究。通过CT、盆腔超声和盆腔MRI进行分期及治疗计划制定。大体肿瘤体积（GTV）定义为MRI或超声显示的子宫内膜条纹宽度，整个子宫体、宫颈和阴道近端代表临床靶体积（CTV）。在每次HDR近距离放射治疗分次中进行剂量计算。
8例患者接受了外照射放疗后再行腔内HDR近距离放射治疗。7例患者仅接受了腔内HDR近距离放射治疗。所有患者中，GTV的90%平均累积剂量（D）在2 Gy分次等效剂量（EQD，α/β = 10）下为95.99 Gy。CTV的平均累积D EQD为51.64 Gy。平均随访时间为29个月。4例患者在治疗完成后平均2.83年死于合并症。除1例（6.6%）患者在治疗完成后9个月复发外，其余患者在随访剩余时间内均无疾病复发。
对于手术条件差且患有早期子宫内膜样型子宫内膜癌的患者，图像引导的HDR腔内近距离放射治疗副作用极小且缓解率高。
