Department of Proton Beam Therapy, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
J Radiat Res. 2022 Sep 21;63(5):772-779. doi: 10.1093/jrr/rrac040.
We analyzed the local control (LC) of cervical squamous cell carcinoma treated by computed tomography (CT)-based image-guided brachytherapy (IGBT) using central shielding (CS). We also examined the value of tumor diameter before brachytherapy (BT) as a factor of LC. In total, 97 patients were analyzed between April 2016 and March 2020. Whole-pelvic (WP) radiotherapy (RT) with CS was performed, and the total pelvic sidewall dose was 50 or 50.4 Gy; IGBT was delivered in 3-4 fractions. The total dose was calculated as the biologically equivalent dose in 2 Gy fractions, and distribution was modified manually by graphical optimization. The median follow-up period was 31.8 months (6.3-63.2 months). The 1- and 2-year LC rates were 89% and 87%, respectively. The hazard ratio was 10.11 (95% confidence interval: 1.48-68.99) for local recurrence in those with a horizontal tumor diameter ≥ 4 cm compared to those with < 4 cm before BT. In CT-based IGBT for squamous cell carcinoma, favorable LC can be obtained in patients with a tumor diameter < 4 cm before BT. However, if the tumor diameter is ≥ 4 cm, different treatment strategies such as employing interstitial-BT for dose escalation may be necessary.
我们分析了使用中央屏蔽（CS）的基于计算机断层扫描（CT）的影像引导近距离放射治疗（IGBT）治疗宫颈鳞状细胞癌的局部控制（LC）。我们还检查了近距离放射治疗（BT）前肿瘤直径作为 LC 因素的价值。总共分析了 2016 年 4 月至 2020 年 3 月之间的 97 名患者。进行了全骨盆（WP）放疗（RT）联合 CS，全骨盆侧壁剂量为 50 或 50.4Gy；IGBT 分为 3-4 个剂量。总剂量计算为 2Gy 剂量分割的生物等效剂量，并通过图形优化手动修改分布。中位随访期为 31.8 个月（6.3-63.2 个月）。1 年和 2 年的 LC 率分别为 89%和 87%。BT 前水平肿瘤直径≥4cm 的患者局部复发的风险比为 10.11（95%置信区间：1.48-68.99）。在 CT 引导的 IGBT 治疗鳞状细胞癌中，BT 前肿瘤直径<4cm 的患者可获得良好的 LC。然而，如果肿瘤直径≥4cm，则可能需要采用间质 BT 进行剂量升级等不同的治疗策略。
