Klin Onkol. 2023 Spring;36(2):96-103. doi: 10.48095/ccko202396.
Brachytherapy (BT) is an integral part of radical radiotherapy (RT) or radiochemotherapy (RCT) in patients who are not suitable candidates for surgery. These are usually patients with locally advanced cervical cancer. The goal of all BT planning eff orts has been, still is, and certainly will continue to be, to defi ne the anatomical boundaries of the tumor and the relationship of the tumor to organs at risk (OARs) as best as possible, using available modern imaging techniques. Image guided adaptive brachytherapy (IGABT) is currently the most advanced method of uterovaginal BT. Adaptive planning allows dose escalation from BT to newly defi ned target volumes, according to the risk of recurrence, which is mainly determined by the level of tumor burden. This dose adaptation based on the response to external RCT is a major change in practice compared to conventional BT planning based on dose prescription to point A. The main advantage of the IGABT concept is that it allows the assessment of individual dose distributions in target volumes and OARs, which in turn leads to improved dose coverage of target volumes while decreasing the volume irradiated by the prescribed dose compared to conventional 2D planning. Purpose: In this review article, I provide a comprehensive up-to-date perspective on this issue, particularly in terms of practical recommendations regarding the defi nition of target volumes, the use of diff erent types of uterovaginal applicators, intraoperative complications, and potential manifestations of late gastrointestinal, genitourinary, and vaginal toxicity.
近距离治疗（BT）是不适合手术的局部晚期宫颈癌患者根治性放疗（RT）或放化疗（RCT）的重要组成部分。所有 BT 计划的目标一直是、现在是、将来也肯定会继续是，尽可能利用现有的现代成像技术来定义肿瘤的解剖边界和肿瘤与危及器官（OARs）的关系。图像引导自适应近距离治疗（IGABT）是目前子宫阴道 BT 中最先进的方法。自适应计划允许根据复发风险，从 BT 对新定义的靶区进行剂量升级，复发风险主要由肿瘤负荷决定。与基于剂量规定至 A 点的传统 BT 计划相比，基于对外部 RCT 反应的这种剂量适应性是实践中的一个重大变化。IGABT 概念的主要优势在于它允许评估靶区和 OAR 中的个体剂量分布，这反过来又导致靶区的剂量覆盖得到改善，同时与传统的 2D 计划相比，减少了规定剂量照射的体积。目的：在这篇综述文章中，我提供了对此问题的全面、最新的观点，特别是在靶区定义、不同类型的子宫阴道施源器的使用、术中并发症以及潜在的胃肠道、泌尿生殖和阴道迟发性毒性表现方面的实用建议。
