Andersen Samuel N, Bonnen Mark D, Ludwig Michelle S, Dalwadi Shraddha M
Radiation Oncology, University of Texas Health San Antonio MD Anderson Cancer Center, San Antonio, USA.
Radiation Oncology, Baylor College of Medicine, Houston, USA.
Cureus. 2024 Feb 2;16(2):e53470. doi: 10.7759/cureus.53470. eCollection 2024 Feb.
The use of stereotactic body radiation therapy (SBRT) is not well studied or reported in the treatment of gynecologic malignancies, despite its success in the definitive management of other cancer sites. This report describes a rigorous quality assurance process for patients to undergo dose escalation to the pelvis via stereotactic photon beam irradiation. Patients who receive SBRT must be ineligible for conventional brachytherapy boost and undergo comprehensive informed consent. Fiducial placement, bowel prep, Foley catheter placement with standardized bladder filling, computerized tomography (CT) simulation with whole-body immobilization, magnetic resonance imaging (MRI)-assisted target delineation, planning aims based on the established brachytherapy literature, and physics consultation for SBRT plan optimization are necessary. Prior to each fraction, the simulation position is reproduced and verified with on-table cone beam CT, and the position is maintained with whole-body immobilization. Following treatment, the treating physician is active in survivorship and toxicity management. Gynecologic SBRT is an ongoing area of study, and preliminary successes in delivering high-quality stereotactic dose escalation suggest prospective investigation is warranted. By adhering to strict quality control measures and following a pre-defined best standard of practice, patients with gynecologic malignancies who are ineligible for traditional brachytherapy procedures can be safely treated with SBRT.
尽管立体定向体部放射治疗（SBRT）在其他癌症部位的确定性治疗中取得了成功，但在妇科恶性肿瘤治疗中的研究和报道并不充分。本报告描述了一个严格的质量保证流程，用于患者通过立体定向光子束照射对盆腔进行剂量递增治疗。接受SBRT的患者必须不符合传统近距离放疗加量的条件，并需获得全面的知情同意。放置基准标记、肠道准备、放置Foley导管并进行标准化膀胱充盈、采用全身固定的计算机断层扫描（CT）模拟、磁共振成像（MRI）辅助靶区勾画、基于既定近距离放疗文献的计划目标以及进行SBRT计划优化的物理会诊都是必要的。在每次分次治疗前，通过治疗台上的锥形束CT重现并验证模拟位置，并通过全身固定保持该位置。治疗后，主治医生积极参与生存和毒性管理。妇科SBRT是一个正在进行研究的领域，在提供高质量立体定向剂量递增方面取得的初步成功表明有必要进行前瞻性研究。通过坚持严格的质量控制措施并遵循预先定义的最佳实践标准，不符合传统近距离放疗程序的妇科恶性肿瘤患者可以安全地接受SBRT治疗。
