Radiation Oncology, Institut de Cancérologie, Libreville, Gabon.
Pract Radiat Oncol. 2018 Jul-Aug;8(4):e224-e230. doi: 10.1016/j.prro.2017.12.002. Epub 2017 Dec 14.
Bowel is often the dose-limiting organ in curative pelvic irradiation because of radiation enteritis when dose exceeds 40 to 45 Gy. To limit radiation enteritis, a silicone tissue-expander prothesis (STEP) connected to a subcutaneous self-sealing valve was prospectively used in children undergoing pelvic or abdominal radiation therapy. This study reports the 15-year long-term outcomes of this prospective series.
Between 1987 and 2008, 29 children from 3 Paris institutions received pelvic radiation therapy after surgical placement of a STEP in the pelvis. The median prescribed dose was 50.4 Gy (44.1-55 Gy) using 5 daily fractions of 1.8 Gy per week, except for 1 patient receiving 4 fractions of 2.5 Gy per week. The median treatment duration was 40 days (29-49 days). After 2000, computed tomography (CT) conformal 3-dimensional radiation therapy was used, and 12 patients had CT simulation. Four had CT before and after insertion of the STEP, enabling us to compare pre- and postprosthesis insertion bowel dose-volume histograms. Acute and late toxicities were captured using the Radiation Therapy Oncology Group or the National Cancer Institute Common Terminology Criteria for Adverse Events 4.0 scale.
No patient experienced significant perioperative complications. Pre- and post-STEP insertion small bowel dose-volume histograms show significant reductions in small bowel: 51%, 45%, and 64%, respectively, in V, V, and V (V = irradiated volume by x Gy). Twenty-five patients (86%) completed their radiation therapy with no or minimal small bowel toxicity. One patient also treated with neutrons developed delayed grade 4 toxicities. The 15-year complication-free survival for those surviving was 70.3%.
We report the long-term follow-up of STEP prosthesis insertion in children to reduce the small bowel volume in the radiation field. The acute and long-term tolerances were excellent. The STEP reduced the bowel dose over 40 Gy by 64%.
由于放射性肠炎，当剂量超过 40 至 45 Gy 时，肠道通常是根治性盆腔照射的剂量限制器官。为了限制放射性肠炎，一种与皮下自密封阀相连的硅酮组织扩张器假体（STEP）被前瞻性地用于接受盆腔或腹部放射治疗的儿童。本研究报告了该前瞻性系列的 15 年长期结果。
1987 年至 2008 年间，来自巴黎 3 家机构的 29 名儿童在骨盆中放置 STEP 后接受了盆腔放射治疗。中位规定剂量为 50.4 Gy（44.1-55 Gy），每周 5 次，每次 1.8 Gy，除 1 名患者每周接受 4 次 2.5 Gy 治疗外。中位治疗时间为 40 天（29-49 天）。2000 年后，采用计算机断层扫描（CT）适形三维放射治疗，12 名患者进行了 CT 模拟。4 名患者在插入 STEP 前后进行了 CT 检查，使我们能够比较假体插入前后的肠道剂量-体积直方图。急性和晚期毒性使用放射治疗肿瘤学组或国家癌症研究所不良事件通用术语标准 4.0 量表进行捕获。
无患者发生明显围手术期并发症。STEP 插入前后的小肠剂量-体积直方图显示小肠显著减少：V 分别为 51%、45%和 64%；V 分别为 51%、45%和 64%；V 分别为 51%、45%和 64%。25 名（86%）患者完成放射治疗，小肠毒性轻微或无。1 名同时接受中子治疗的患者发生迟发性 4 级毒性。存活者 15 年无并发症生存率为 70.3%。
我们报告了 STEP 假体插入以减少放射野中小肠体积的儿童的长期随访结果。急性和长期耐受性均良好。STEP 将 40 Gy 以上的肠道剂量降低了 64%。
