Department of Radiation Oncology, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA.
Department of Obstetrics and Gynecology, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA.
Gynecol Oncol. 2019 Feb;152(2):353-360. doi: 10.1016/j.ygyno.2018.11.020. Epub 2018 Nov 16.
To evaluate the efficacy, feasibility and safety of image-based, inversely and adaptively planned high-dose rate interstitial brachytherapy (HDR-ISBT) to treat advanced primary or recurrent gynecologic malignancy in a single implant, three-consecutive-day regimen.
Clinical demographics and outcome data were abstracted from all patients with primary and recurrent gynecologic malignancies who received HDR-ISBT boost from 2014 to 2017. Treatment consisted of a single implant (~7 Gy × 4 fractions) of interstitial needles using the Syed-Neblett template over a three-day hospital admission. CT-based (3D) simulation with inverse and adaptive planning was utilized for each fraction. MR prior to and MR immediately after external beam therapy were fused for HDR-ISBT target delineation.
Forty women with an overall median follow-up of 18 months (range: 6-54 months) received an HDR-ISBT boost. Of the 30 primary cases (83% cervix, 10% vaginal, 7% uterine), 44% had organ invasion (bladder, rectal or both) on MRI. Median coverage and dose are reported (V: 98%, HR-CTV EQD: 85.1 Gy, D: 92 Gy). A significant association existed between rectal doses exceeding GEC-ESTRO recommendations (D < 75 Gy) and the development of grade 3 gastrointestinal toxicity with a relative risk of 1.4 [1.1-1.8] (p = .046). Actuarial two-year overall survival (OS), local control (LC) and progression-free survival (PFS) were 81%, 81% and 64%, respectively.
A four fraction, inversely and adaptively planned, single-implant approach of image-based HDR-ISBT provides excellent coverage, minimal toxicity and effective local control in patients with advanced and recurrent disease.
评估基于图像的逆向自适应计划高剂量率间质近距离放疗（HDR-ISBT）在单次植入、连续三天方案中治疗晚期原发性或复发性妇科恶性肿瘤的疗效、可行性和安全性。
从 2014 年至 2017 年期间，所有接受 HDR-ISBT 推量治疗的原发性和复发性妇科恶性肿瘤患者中提取临床人口统计学和结果数据。治疗包括在三天住院期间使用 Syed-Neblett 模板进行单次植入（约 7Gy×4 分次）间质针。每次分割均采用基于 CT（3D）的逆向和自适应计划进行模拟。外照射治疗前后的磁共振（MR）融合用于 HDR-ISBT 靶区勾画。
40 名女性患者的中位随访时间为 18 个月（范围：6-54 个月），接受了 HDR-ISBT 推量治疗。30 例原发性肿瘤患者中（83%为宫颈癌，10%为阴道癌，7%为子宫癌），44%的患者在 MRI 上有器官侵犯（膀胱、直肠或两者均有）。报道了中位覆盖和剂量（V：98%，HR-CTV EQD：85.1Gy，D：92Gy）。直肠剂量超过 GEC-ESTRO 建议（D<75Gy）与 3 级胃肠道毒性的发生之间存在显著相关性，相对风险为 1.4[1.1-1.8]（p=0.046）。两年总生存率（OS）、局部控制率（LC）和无进展生存率（PFS）分别为 81%、81%和 64%。
基于图像的 HDR-ISBT 采用四分次、逆向自适应计划、单次植入方法，为晚期和复发性疾病患者提供了极好的覆盖范围、最小的毒性和有效的局部控制。
