Knocke T H, Kucera H, Weidinger B, Höller W, Pötter R
Universitätsklinik für Strahlentherapie und Strahlenbiologie, Allgemeines Krankenhaus der Stadt Wien.
Strahlenther Onkol. 1995 Apr;171(4):195-201.
In general the results of radiotherapy are regarded to be inferior compared to those of surgery, when it comes to the treatment of endometrial carcinoma, but some patients are elderly and have multiple medical problems, which make them inoperable. The risk of intracavitary radium therapy, caused by immobilisation, can be reduced by the use of fractionated high-dose-rate afterloading brachytherapy. With this method there are only very few results reported.
Treatment results of HDR brachytherapy (4 to 5 times 8.5 Gy, one-channel applicator, intracavitary and 1 to 2 times 7 Gy intravaginal) at the University Hospital Vienna were analysed retrospectively (actuarial method [Kaplan-Meier]) regarding overall survival and recurrence-free interval according to stage and histology. Over a period from April 1981 until December 1992 325 patients were treated by this technique alone or combined with external beam therapy. Two hundred and eighty patients could be evaluated. Staging based on clinical examination and fractionated curettage.
Five-year overall survival was 58.1%, in stage Ia 68.5%, stage Ib 49.9%, stage II 48.7%, according to histopathologic grading 1 68.5%, grade 2 53.2%, grade 3 37.5%. 64 patients developed a recurrence after a median of 13 months, 45 of those a local recurrence only, 6 a local recurrence with distant metastases, 6 a lymph node recurrence only and 7 patients distant metastases only.
These results are at least comparable to those of intracavitary radium therapy and low-dose-rate afterloading techniques. Better local control rates should be obtained by the Heyman packing method using Norman-Simon applicators based on individualised brachytherapy treatment planning, which optimises dose distribution according to the target volume based on computerised imaging.
一般而言，在子宫内膜癌的治疗中，与手术治疗结果相比，放疗结果被认为较差，但有些患者年事已高且有多种内科问题，这使得他们无法进行手术。通过使用分次高剂量率后装近距离放疗，可降低因固定导致的腔内镭疗风险。关于这种方法，仅有极少的结果报道。
对维也纳大学医院采用高剂量率近距离放疗（4至5次，每次8.5 Gy，单通道施源器，腔内照射，以及1至2次，每次7 Gy阴道内照射）的治疗结果进行回顾性分析（精算方法[Kaplan-Meier]），根据分期和组织学分析总生存率和无复发生存期。在1981年4月至1992年12月期间，325例患者接受了该技术单独治疗或联合外照射治疗。其中280例患者可进行评估。分期基于临床检查和分次刮宫。
五年总生存率为58.1%；Ia期为68.5%，Ib期为49.9%，II期为48.7%；根据组织病理学分级，1级为68.5%，2级为53.2%，3级为37.5%。64例患者在中位时间13个月后出现复发，其中45例仅为局部复发，6例为局部复发伴远处转移，6例仅为淋巴结复发，7例仅为远处转移。
这些结果至少与腔内镭疗和低剂量率后装技术的结果相当。通过使用基于诺曼 - 西蒙施源器的海曼填塞法，基于个体化近距离放疗治疗计划，根据计算机成像按靶体积优化剂量分布，应能获得更好的局部控制率。
