Sarkaria J N, Petereit D G, Stitt J A, Hartman T, Chappell R, Thomadsen B R, Buchler D A, Fowler J F, Kinsella T J
Department of Human Oncology, University of Wisconsin School of Medicine, Madison 53792.
Int J Radiat Oncol Biol Phys. 1994 Aug 30;30(1):75-82; discussion 247. doi: 10.1016/0360-3016(94)90521-5.
To compare the outcome and complication rates for treatment of uterine cervical carcinoma with low dose-rate (LDR) vs. high dose-rate (HDR) brachytherapy at the University of Wisconsin Comprehensive Cancer Center (UWCCC).
One-hundred ninety-eight evaluable patients with cervical carcinoma, Stages IB to IIIB, treated with curative intent with a combination of megavoltage teletherapy and LDR brachytherapy from 1977 to 1988 were the subject of an initial review. In 1989, a HDR treatment program was initiated where all patients with cervical carcinoma were subsequently treated with a combination of HDR brachytherapy and teletherapy. Using the linear-quadratic model (LQ), the dose and schedule of HDR brachytherapy and teletherapy were designed to give similar tumor control and late effects as LDR therapy. Technically, the HDR schedule required meticulous attention to treatment geometry to limit severe late effects. Forty patients treated with the HDR program with 2-4 year follow-up were reviewed and compared to the previous LDR patient group. The LDR and HDR treatment groups were comparable with regards to age, weight, stage distribution, bulk of disease, and histology.
No significant difference in survival was found between the LDR and HDR groups with 3-year actuarial overall survival being 66% and 77%, respectively. Three-year actuarial pelvic control rates were similar at 80% and 77% for the LDR and HDR groups, respectively. No significant difference in late treatment complications requiring hospitalization or surgery was found between the two treatment groups with a complication rate of 10% (20/198) for the LDR patients and 2.5% (1/40) for the HDR patients.
As predicted by our LQ calculations, treatment results for LDR and HDR brachytherapy were similar with respect to survival, pelvic control and late complications in the treatment of cervical carcinoma. The HDR brachytherapy program at the UWCCC appears to be a safe and effective alternative to LDR therapy in the treatment of cervical carcinoma.
在威斯康星大学综合癌症中心（UWCCC）比较低剂量率（LDR）与高剂量率（HDR）近距离放射治疗子宫颈癌的疗效和并发症发生率。
对1977年至1988年期间198例可评估的IB至IIIB期子宫颈癌患者进行了初步回顾，这些患者接受了兆伏远距离放射治疗和LDR近距离放射治疗联合的根治性治疗。1989年启动了HDR治疗计划，此后所有子宫颈癌患者均接受了HDR近距离放射治疗和远距离放射治疗联合治疗。使用线性二次模型（LQ），设计HDR近距离放射治疗和远距离放射治疗的剂量和方案，使其在肿瘤控制和晚期效应方面与LDR治疗相似。从技术上讲，HDR方案需要对治疗几何形状给予精心关注，以限制严重的晚期效应。对40例接受HDR方案治疗且有2至4年随访的患者进行了回顾，并与之前的LDR患者组进行了比较。LDR和HDR治疗组在年龄、体重、分期分布、疾病体积和组织学方面具有可比性。
LDR组和HDR组的生存率无显著差异，3年精算总生存率分别为66%和77%。LDR组和HDR组的3年精算盆腔控制率相似，分别为80%和77%。两个治疗组在需要住院或手术的晚期治疗并发症方面无显著差异，LDR患者的并发症发生率为10%（20/198），HDR患者为2.5%（1/40）。
正如我们的LQ计算所预测的，LDR和HDR近距离放射治疗在子宫颈癌治疗中的生存、盆腔控制和晚期并发症方面的治疗结果相似。UWCCC的HDR近距离放射治疗方案似乎是LDR治疗子宫颈癌的一种安全有效的替代方案。
