Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Center, Villejuif, France.
French Military Health Academy, Paris, France.
CA Cancer J Clin. 2019 Sep;69(5):386-401. doi: 10.3322/caac.21578. Epub 2019 Jul 30.
Brachytherapy is a specific form of radiotherapy consisting of the precise placement of radioactive sources directly into or next to the tumor. This technique is indicated for patients affected by various types of cancers. It is an optimal tool for delivering very high doses to the tumor focally while minimizing the probability of normal tissue complications. Physicians from a wide range of specialties may be involved in either the referral to or the placement of brachytherapy. Many patients require brachytherapy as either primary treatment or as part of their oncologic care. On the basis of high-level evidence from randomized controlled trials, brachytherapy is mainly indicated: 1) as standard in combination with chemoradiation in patients with locally advanced cervical cancer; 2) in surgically treated patients with uterine endometrial cancer for decreasing the risk of vaginal vault recurrence; 3) in patients with high-risk prostate cancer to perform dose escalation and improve progression-free survival; and 4) in patients with breast cancer as adjuvant, accelerated partial breast irradiation or to boost the tumor bed. In this review, the authors discuss the clinical relevance of brachytherapy with a focus on indications, levels of evidence, and results in the overall context of radiation use for patients with cancer.
近距离治疗是一种特定形式的放射治疗，包括将放射性源直接置于或靠近肿瘤内。该技术适用于患有各种类型癌症的患者。它是一种将非常高剂量聚焦于肿瘤而最小化正常组织并发症的概率的理想工具。来自广泛专业领域的医生可能会参与近距离治疗的转诊或放置。许多患者需要近距离治疗作为主要治疗或肿瘤治疗的一部分。基于随机对照试验的高级别证据，近距离治疗主要适用于：1）与局部晚期宫颈癌的放化疗联合作为标准治疗；2）在接受手术治疗的子宫内膜癌患者中，降低阴道穹窿复发的风险；3）在高危前列腺癌患者中进行剂量升级，改善无进展生存期；4）在乳腺癌患者中作为辅助治疗、加速部分乳腺照射或肿瘤床增强。在这篇综述中，作者讨论了近距离治疗的临床相关性，重点讨论了适应症、证据水平以及在癌症患者放射治疗的整体背景下的结果。
