Shimizu Yuri, Murakami Naoya, Chiba Takahito, Kaneda Tomoya, Okamoto Hiroyuki, Nakamura Satoshi, Takahashi Ayaka, Kashihara Tairo, Takahashi Kana, Inaba Koji, Okuma Kae, Nakayama Yuko, Itami Jun, Igaki Hiroshi
Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan.
Department of Medical Physics, National Cancer Center Hospital, Tokyo, Japan.
Front Oncol. 2022 Jan 26;11:808721. doi: 10.3389/fonc.2021.808721. eCollection 2021.
High-dose-rate interstitial brachytherapy (HDR-ISBT) is recommended to obtain a better local tumor control for uterine cancer patients in specific situations such as bulky lesions, an extension to the lateral parametrium, or tumors with irregular shapes. Our group uses real-time transrectal ultrasonography (TRUS) to guide freehand interstitial needle insertion. Occasionally, target tumors locate deeper beyond the rectum and cannot be visualized by TRUS. CT can guide needles to deeply located tumors, but in such cases, repeated image obtainment is required to achieve ideal needle localization. In this report, we present nine cases of patients who underwent HDR-ISBT for deeply situated tumors guided by a combination of transrectal and transabdominal ultrasonography (TR/TA-US).
Nine uterine cancer patients whose tumors were located deeper than the reach of TRUS and underwent HDR-ISBT guided by TR/TA-US were presented. All nine cases had no distal organ metastasis and underwent external beam radiation therapy (EBRT) to the pelvic region for 45-50.4 Gy in 25-28 fractions followed by boost HDR-ISBT for deeply situated tumors guided by TR/TA-US.
There were seven cervical cancer and two endometrial cancer patients: six with extensive uterine corpus invasion, one cervical cancer with massive pelvic lymph node metastasis, one cervical cancer with postoperative pelvic recurrence, and one with left ovarian direct tumor invasion. The median follow-up period was 15 months (range 3-28 months). The average clinical target volume at the time of first HDR-ISBT was 131 ml (range 44-335 ml). The linear distance from the vaginal entrance to the deepest part of the tumor at first time brachytherapy of nine cases was 14.0 (9.0-17.0) cm. HDR-ISBT dose fractionation was 24-30 Gy in four or five fractions. Seven out of nine cases had no local recurrence in the follow-up period. One had local in-field recurrence 25 months after HDR-ISBT. Another case with carcinosarcoma could not obtain local control and underwent salvage hysterectomy for a residual uterine tumor 11 months after HDR-ISBT. Four cases had extra-field recurrence in lymph nodes or distant organs.
In brachytherapy for gynecologic malignancies, deeply situated tumors located out of reach of TRUS may obtain favorable local control by HDR-ISBT guided with TR/TA-US.
对于子宫癌患者，在诸如巨大病灶、侵犯侧盆壁或形状不规则的肿瘤等特定情况下，推荐采用高剂量率组织间近距离放疗（HDR-ISBT）以获得更好的局部肿瘤控制。我们团队采用实时经直肠超声（TRUS）引导徒手组织间插针。偶尔，靶肿瘤位于直肠深部以外，TRUS无法显示。CT可引导针进入深部肿瘤，但在这种情况下，需要反复获取图像以实现理想的针定位。在本报告中，我们介绍了9例经直肠和经腹超声联合引导（TR/TA-US）对深部肿瘤进行HDR-ISBT治疗的患者。
介绍了9例子宫癌患者，其肿瘤位于TRUS探测范围之外，并接受了TR/TA-US引导下的HDR-ISBT治疗。所有9例患者均无远处器官转移，先行盆腔外照射放疗（EBRT），剂量为45-50.4 Gy，分25-28次，随后在TR/TA-US引导下对深部肿瘤进行HDR-ISBT推量治疗。
7例为宫颈癌患者，2例为子宫内膜癌患者：6例有广泛的子宫体侵犯，1例宫颈癌有大量盆腔淋巴结转移，1例宫颈癌术后盆腔复发，1例有左侧卵巢直接肿瘤侵犯。中位随访期为15个月（范围3-28个月）。首次HDR-ISBT时的平均临床靶体积为131 ml（范围44-335 ml）。9例患者首次近距离放疗时从阴道口到肿瘤最深部的直线距离为14.0（9.0-17.0）cm。HDR-ISBT剂量分割为24-30 Gy，分4或5次。9例中有7例在随访期内无局部复发。1例在HDR-ISBT后25个月出现局部野内复发。另一例肉瘤患者未能获得局部控制，在HDR-ISBT后11个月因残留子宫肿瘤接受了挽救性子宫切除术。4例在淋巴结或远处器官出现野外复发。
在妇科恶性肿瘤的近距离放疗中，位于TRUS探测范围之外的深部肿瘤通过TR/TA-US引导的HDR-ISBT可能获得良好的局部控制。
