Zhao Xiujuan, Wu Haiyan, Yi Ruotong, Chen Duke, Tang Ying, Zhou Qi, Zou Dongling
Department Of Gynecology Oncology Center, Chongqing University Cancer Hospital, 181 Hanyu Road, Shangpingba District, Chongqing, 400030, China.
Department of Publicity and Health Education, Chongqing University Cancer Hospital, Chongqing, China.
Sci Rep. 2025 Jul 9;15(1):24681. doi: 10.1038/s41598-025-02779-1.
To investigate the ramifications of dose alterations and clinical outcomes linked to imperfect uterine tandem implantation within high dose rate brachytherapy (HDR-brachytherapy) for cervical cancer. A retrospective analysis was conducted on imperfect intrauterine insertion images from November 2020 to July 2021. The physicist reconfigured two-dimensions (2D) and three-dimensions (3D) plans based on prescription (6 Gy) for both the imperfection (IM) and perfect (PER) implantation. A paired t-test was employed to assess (reference volume of clinical target volume) CTV, (reference isodose) V, (conformal index) COIN, (equivalent dose in 2-Gy fractions) EQD of (organs at risks) OARs, (tumor control probability) TCP, and (normal tissue complication probability) NTCP. Among 1742 brachytherapy insertions, 38 (2.18%) instances of imperfect images were identified in 24 out of 319 patients (7.52%). COIN > 0.64 met the prescribed requirements solely in the PER-3D group. For inadequate implantation, the IM-3D-group showed enhancements in EQD of OARs and NTCP for the rectum, sigmoid colon, and small intestine, whereas NTCP of the bladder was augmented in the IM-2D-group. Regarding anterior wall perforation, the IM-group exhibited increases in EQD and NTCP for the rectum and small intestine, along with EQD for the bladder in 3D. In the IM-2D-group demonstrated increases in EQD for the bladder, rectum, and small intestine, as well as NTCP for the sigmoid and small intestine. In cases of posterior wall perforation, the IM-3D-group showcased augmented EQD for the bladder and rectum, and NTCP for the rectum and sigmoid. Conversely, EQD was solely increased in the rectum in the 2D context. Finally, in instances of fundus perforation, the IM-group exhibited heightened EQD for the sigmoid. Imperfect uterine tube implantation leads to worse clinical outcomes and greater adverse reactions.
为研究高剂量率近距离放疗（HDR - 近距离放疗）治疗宫颈癌时，子宫串联植入不完美与剂量改变及临床结果之间的影响。对2020年11月至2021年7月子宫内植入不完美的图像进行回顾性分析。物理学家根据处方（6 Gy）对不完美（IM）和完美（PER）植入分别重新配置二维（2D）和三维（3D）计划。采用配对t检验评估临床靶区（CTV）的参考体积、参考等剂量线（V）、适形指数（COIN）、危及器官（OARs）的等效剂量（2 Gy分次）（EQD）、肿瘤控制概率（TCP）和正常组织并发症概率（NTCP）。在1742次近距离放疗植入中，319例患者中有24例（7.52%）出现38例（2.18%）植入图像不完美的情况。仅在PER - 3D组中COIN＞0.64满足规定要求。对于植入不充分，IM - 3D组中直肠、乙状结肠和小肠的OARs的EQD和NTCP升高，而IM - 2D组中膀胱的NTCP升高。关于前壁穿孔，IM组中直肠和小肠的EQD和NTCP升高，3D时膀胱的EQD也升高。IM - 2D组中膀胱、直肠和小肠的EQD升高，乙状结肠和小肠的NTCP升高。在后壁穿孔的情况下，IM - 3D组中膀胱和直肠的EQD升高，直肠和乙状结肠的NTCP升高。相反，在2D情况下仅直肠的EQD升高。最后，在宫底穿孔的情况下，IM组中乙状结肠的EQD升高。子宫输卵管植入不完美会导致更差的临床结果和更严重的不良反应。
