Ali Nasir, Qureshi Bilal Mazhar, Abbasi Ahmed Nadeem, Hafiz Asim, Khan Benazir Mir, Jangda Abdul Qadir
Radiation Oncology Section, Department of Oncology, The Aga Khan University, Karachi, Pakistan.
J Coll Physicians Surg Pak. 2020 Sep;30(9):974-979. doi: 10.29271/jcpsp.2020.09.974.
To determine the acute vaginal mucosal toxicity and clinical response of cervical cancer after definitive treatment with external beam radiotherapy (EBRT) and three fractions each of 8 Fray (Gy) high dose rate intracavitary brachytherapy (HDR-BT).
Descriptive study.
Radiation Oncology Section, Department of Oncology, The Aga Khan University Hospital, Karachi, Pakistan from January 2008 till December 2015.
Protocol was formulated for carcinoma cervix to complete treatment in 7 weeks. Patients were treated with chemotherapy and pelvic EBRT to a total dose of 45 Gy/25 fractions, followed by three intracavitary HDR brachytherapy fractions of 8 Gy each. Vaginal toxicity and local clinical response was assessed at the end of treatment, at 4 and 8 weeks.
A total of 57 patients were treated with HDR brachytherapy and 49 patients were evaluated for assessment of toxicity and response. According to FIGO staging system, two had stage IB2, one had IIA, thirty-six had IIB, seven had IIIB, one had IVA disease and two had IVB with para aortic nodes. Concurrent gemcitabine and cisplatin were given to 26 (46%); whereas, 28 (49%) received concurrent cisplatin alone. Grade III acute vaginal mucosal toxicity was seen in 52 and Grade IV acute vaginal mucosal toxicity was observed in 08 patients. At completion of treatment, 40 patients had complete clinical response, at 4 weeks follow-up, complete regression of disease was found in 3 more and at 8 weeks none had clinical residual disease.
This regimen of HDR brachytherapy treatments is feasible, efficacious, and well-tolerated for carcinoma cervix in a setup with cost constraints. Long term toxicity and disease control remains to be reported with longer follow-up. Key Words: Carcinoma cervix, High dose rate brachytherapy, Acute toxicity, Local response, External beam radiation therapy, Intracavitary brachytherapy.
确定外照射放疗（EBRT）及三次每次8弗（戈瑞）高剂量率腔内近距离放疗（HDR-BT）根治性治疗宫颈癌后的急性阴道黏膜毒性及临床反应。
描述性研究。
2008年1月至2015年12月，巴基斯坦卡拉奇阿迦汗大学医院肿瘤内科放疗科。
制定宫颈癌治疗方案，在7周内完成治疗。患者接受化疗及盆腔EBRT，总剂量45 Gy/25次，随后进行三次每次8 Gy的腔内HDR近距离放疗。在治疗结束时、4周和8周评估阴道毒性及局部临床反应。
共有57例患者接受了HDR近距离放疗，49例患者接受毒性和反应评估。根据国际妇产科联盟（FIGO）分期系统，2例为IB2期，1例为IIA期，36例为IIB期，7例为IIIB期，1例为IVA期疾病，2例为IVB期伴腹主动脉旁淋巴结转移。26例（46%）患者同时接受吉西他滨和顺铂治疗；而28例（49%）患者仅接受顺铂治疗。52例患者出现III级急性阴道黏膜毒性，8例患者出现IV级急性阴道黏膜毒性。治疗结束时，40例患者临床完全缓解，4周随访时，又有3例疾病完全消退，8周时无临床残留疾病。
在成本受限的情况下，这种HDR近距离放疗方案对宫颈癌可行、有效且耐受性良好。长期毒性和疾病控制情况有待更长时间随访后报告。关键词：宫颈癌；高剂量率近距离放疗；急性毒性；局部反应；外照射放疗；腔内近距离放疗
