Department of Radiotherapy Oncology, Hainan Cancer Hospital, Haikou, China.
Department of Ultrasonography, Hainan Cancer Hospital, Haikou, China.
Medicine (Baltimore). 2023 Sep 15;102(37):e34904. doi: 10.1097/MD.0000000000034904.
Cervical cancer is the fourth most frequently diagnosed cancer and the fourth leading cause of cancer death in women. This study explored the effectiveness and safety of ultrasound-CT guided 3D intracavitary and interstitial brachytherapy (US-CT-3D-IGBT) in the treatment of larger cervical cancer with bleeding. A retrospective study was conducted on 31 patients with larger cervical squamous cell carcinoma (tumor short diameter >4 cm) with vaginal bleeding. US-CT-3D-IGBT was used to deliver a single high-dose prescription of high-risk clinical target volume (HR-CTV) 1000 to 1200 centigray (cGy) to the cervical tumor, followed by conventional intensity-modulated radiation therapy (IMRT) synchronous chemoradiotherapy (45-50 gray (Gy)/25-28 fraction(f)) with weekly cisplatin 25 mg/m2. After external radiotherapy, simple intracavitary brachytherapy (BT) combined with manual interstitial BT was administered at 30 Gy/5F or 28 Gy/4F. Within 24 hours after high-dose 3D-IGBT, bleeding stopped in 2 patients (6.4%), and bleeding was reduced in a total of 11 patients (35.4%) within 48 hours. A total of 29 patients achieved hemostasis within 72 hours, with an effective rate of 93.5%. The remaining 2 patients reached the clinical hemostasis requirement on the 4th and 5th day. All patients experienced a significant reduction in vaginal bleeding after the initial BT, with an average reduction of 66 mL (160-20 mL). US-CT-3D-IGBT is effective in rapidly controlling bleeding in patients with larger cervical cancer (tumor short diameter >4 cm), and the treatment is relatively safe and feasible.
宫颈癌是第四大常见癌症，也是女性癌症死亡的第四大主要原因。本研究探讨了超声 CT 引导 3D 腔内和间质近距离放疗（US-CT-3D-IGBT）治疗较大宫颈鳞癌（肿瘤短径>4cm）出血的有效性和安全性。对 31 例阴道出血的较大宫颈鳞癌（肿瘤短径>4cm）患者进行回顾性研究。采用 US-CT-3D-IGBT 对宫颈肿瘤给予高风险临床靶区（HR-CTV）单次高剂量处方 1000 至 1200 厘戈瑞（cGy），随后行常规调强放疗（IMRT）同步化疗（45-50 戈瑞（Gy）/25-28 次（f）），每周顺铂 25mg/m2。外照射后，行单纯腔内放疗（BT）联合手动间质 BT，给予 30Gy/5F 或 28Gy/4F。在高剂量 3D-IGBT 后 24 小时内，2 例（6.4%）出血停止，48 小时内共 11 例（35.4%）出血减少。29 例患者在 72 小时内达到止血，有效率为 93.5%。另外 2 例患者在第 4 天和第 5 天达到临床止血要求。所有患者在初始 BT 后阴道出血均明显减少，平均减少 66mL（160-20mL）。US-CT-3D-IGBT 能迅速控制较大宫颈癌（肿瘤短径>4cm）患者的出血，治疗相对安全可行。
