Le Pechoux C, Akine Y, Sumi M, Tokuuye K, Ikeda H, Yajima M, Yamada T, Tanemura K, Tsunematsu R, Ohmi K
Department of Radiation Therapy, National Cancer Center Hospital, Tokyo.
Int J Radiat Oncol Biol Phys. 1995 Feb 15;31(4):735-41. doi: 10.1016/0360-3016(94)00573-7.
There is no consensus as to the best dose-fractionation regimen in high dose rate (HDR) brachytherapy for cervix cancer. Since 1983, two fractionation regimens have been used in different time periods at National Cancer Center Hospital, and their treatment results have been compared in terms of 5-year survival, local control, and complication rate to find the better therapeutic regimen.
From November 1983 to October 1990, 130 patients with uterine cervix carcinoma were treated with HDR intracavitary brachytherapy using a remote afterloading system. There were 21 Stage Ib patients, 5 Stage IIa, 29 Stage IIb, 2 Stage IIIa, 68 Stage IIIb, and 5 Stage IVa. The median age was 64 years. The median follow-up time was 50 months. Radiotherapy consisted of external beam irradiation to the pelvis (mean dose of 50 Gy), combined with HDR brachytherapy (mean dose of 20 Gy to point A) given 5 Gy per session twice weekly (group A: 54 patients) or 6 Gy once weekly (group B: 76 patients).
The overall 5-year survival was 52% in group A and 72% in group B. Local recurrence rate was 11%, and distant failure rate was 21%, with no difference between the two groups. The complication rate was significantly lower in group B (37%) than in group A (55%). Multivariate analysis has shown that factors affecting survival were stage, brachytherapy dose, and local control status. No factor was predictive of local control, but the external beam radiation dose significantly influenced the risk of complications.
The once-weekly HDR intracavitary applications combined with properly adjusted external beam pelvic irradiation is a safe and effective treatment for patients with uterine cervix cancer.
对于子宫颈癌高剂量率（HDR）近距离放射治疗的最佳剂量分割方案尚无共识。自1983年以来，国立癌症中心医院在不同时间段采用了两种分割方案，并从5年生存率、局部控制率和并发症发生率方面比较了它们的治疗效果，以找出更好的治疗方案。
1983年11月至1990年10月，130例子宫颈癌患者采用遥控后装系统进行HDR腔内近距离放射治疗。其中Ib期21例，IIa期5例，IIb期29例，IIIa期2例，IIIb期68例，IVa期5例。中位年龄为64岁。中位随访时间为50个月。放射治疗包括盆腔外照射（平均剂量50 Gy），联合HDR近距离放射治疗（A点平均剂量20 Gy），A组每周两次，每次5 Gy（54例患者），B组每周一次，每次6 Gy（76例患者）。
A组的总体5年生存率为52%，B组为72%。局部复发率为11%，远处失败率为21%，两组之间无差异。B组的并发症发生率（37%）明显低于A组（55%）。多因素分析表明，影响生存的因素有分期、近距离放射治疗剂量和局部控制情况。没有因素可预测局部控制情况，但外照射剂量显著影响并发症风险。
对于子宫颈癌患者，每周一次的HDR腔内照射联合适当调整的盆腔外照射是一种安全有效的治疗方法。
