Esche B A, Crook J M, Horiot J C
Int J Radiat Oncol Biol Phys. 1987 Aug;13(8):1183-92. doi: 10.1016/0360-3016(87)90193-3.
Pelvic failures and late radiation sequelae were analyzed using the dosimetric parameters of ICRU Report 38 for 338 patients with Stage I-III carcinoma of the uterine cervix treated by radiation alone and followed for a minimum of 2 years. The pelvic recurrence rates were: Stage IB 5.1% (N = 118, 1% pelvis alone), Stage IIA 15.1% (N = 53, 9.4% pelvis alone), Stage IIB 15.8% (N = 76, 9.2% pelvis alone) and Stage IIIB 28.9% (N = 76, 17.1% pelvis alone). For Stages I and II pelvic failure was unrelated to cumulated lateral parametrial dose (CDPW) or reference volumes, but for Stage IIIB was higher for CDPW above 65 Gy. Overall complication rates were: grade 3-10.1% and grade 2-18.1% but were much lower for 176 patients treated with stem and ovoids (S + O: grade 3-5.7%, grade 2-15.7%) than for 43 receiving vaginal cylinders (grade 3-37.2%, grade 2-28%). Grade 3 rectal complications associated with cylinders were related to a maximal vaginal application over 1.50 cGy X m2 of total reference air kerma (or 2080 mgh) and cumulated rectal reference doses (CDRref) above 75 Gy. For the S + O group, grade 2 and 3 rectal complications increased with increasing reference volumes (hwt and HWT) and showed dose thresholds for CDRref and CDRmean (grade 3: 75 Gy). Prospective use of zones of risk defined graphically on a dose-volume plot (CDRref vs HWT) has reduced our severe complication rate without reducing local control. This technique requires individualization of patient therapy, rapid access to computerized dosimetry and the establishment of center- and applicator-specific risks of complications.
对338例仅接受放疗且随访至少2年的Ⅰ - Ⅲ期子宫颈癌患者，采用ICRU报告38的剂量学参数分析盆腔失败情况和晚期放疗后遗症。盆腔复发率分别为：ⅠB期5.1%（N = 118，仅盆腔复发1%），ⅡA期15.1%（N = 53，仅盆腔复发9.4%），ⅡB期15.8%（N = 76，仅盆腔复发9.2%），ⅢB期28.9%（N = 76，仅盆腔复发17.1%）。对于Ⅰ期和Ⅱ期，盆腔失败与累积侧方宫旁组织剂量（CDPW）或参考体积无关，但对于ⅢB期，当CDPW高于65 Gy时盆腔失败率更高。总体并发症发生率为：3级 - 10.1%，2级 - 18.1%，但对于176例使用施源器和卵圆体治疗的患者（S + O：3级 - 5.7%，2级 - 15.7%），并发症发生率远低于43例使用阴道施源器的患者（3级 - 37.2%，2级 - 28%）。与施源器相关的3级直肠并发症与总参考空气比释动能超过1.50 cGy X m2（或2080 mgh）的最大阴道照射剂量以及累积直肠参考剂量（CDRref）高于75 Gy有关。对于S + O组，2级和3级直肠并发症随参考体积（hwt和HWT）增加而增加，并显示出CDRref和CDRmean的剂量阈值（3级：75 Gy）。在剂量 - 体积图（CDRref与HWT）上以图形方式定义风险区域的前瞻性应用降低了我们的严重并发症发生率，同时未降低局部控制率。该技术需要个体化的患者治疗、快速获取计算机化剂量测定结果以及建立特定中心和施源器的并发症风险。
