Kapp K S, Stuecklschweiger G F, Kapp D S, Poschauko J, Pickel H, Hackl A
Division of Radiation Oncology, University Clinic of Diagnostic Radiology, Graz, Austria.
Radiother Oncol. 1997 Feb;42(2):143-53. doi: 10.1016/s0167-8140(96)01881-6.
There is still a concern that the use of HDR brachytherapy might result in an increase of late tissue damage. This restrospective study evaluates the incidence and severity of late complications in patients with carcinoma of the cervix who underwent combined external beam radiation (EBR) and Ir-192 HDR brachytherapy and attempts to identify pretreatment and treatment parameters correlating with late complications.
Between 1985 and 1992, 161 patients with carcinoma of the cervix (FIGO stages IB-IVB) received EBR to the pelvis (ave, max. dose 48.8 Gy) followed by 1-6 Ir-192 HDR placements (median 2). Doses to point A ranged from 8.5 to 38.7 Gy (median 17 Gy). Parameters examined included age, diabetes, obesity, history of inflammatory bowel disease or diverticulitis, prior surgery, hemoglobin level, FIGO stage, EBR dose, technique and daily dose fraction, number of HDR treatments and total dose to point A, maximum doses to bladder and rectum delivered by brachytherapy and cumulative dose to point A. Median follow-up for all patients was 37 months. Complications were rated using an in-house scoring system and according to the French-Italian Glossary (FIG).
Actuarial 5-year survival was 93%, 57%, 46%, and 0% for stages IB, II, IIIB, and IV, respectively. Of 161 patients, 11% developed moderate and 3.7% severe sequelae (FIG: 2.5%, 3.7%). Since some patients experienced more than one complication, the overall incidence was 13.6% and 4.9% (FIG: 3.1%, 4.9%) with respective 5-year actuarial rates of 14% and 5% for moderate, and 2% and 8% for severe bowel and genitourinary tract complications (FIG: 3.5%, 0, and 2%, 8%). All severe bowel complications occurred within 1.5 years whereas urinary tract sequelae continued to develop throughout the follow-up period. FIGO stage was associated with a significant increase in late sequelae (P = 0.015). Analysis of the remaining pretreatment and treatment parameters failed to reveal any statistically significant correlation with moderate or severe sequelae.
In our series using HDR brachytherapy, complication and survival rates were comparable with other series employing either LDR or HDR procedures. Of all parameters analysed, stage of disease was the only parameter significantly correlated with complications in univariate and multivariate analysis.
人们仍然担心高剂量率近距离放射治疗（HDR近距离放疗）的使用可能会导致晚期组织损伤增加。本回顾性研究评估了接受外照射放疗（EBR）联合Ir-192 HDR近距离放疗的宫颈癌患者晚期并发症的发生率和严重程度，并试图确定与晚期并发症相关的治疗前和治疗参数。
1985年至1992年间，161例宫颈癌患者（国际妇产科联盟（FIGO）分期为IB-IVB期）接受盆腔EBR（平均最大剂量48.8 Gy），随后进行1-6次Ir-192 HDR置管（中位数为2次）。A点剂量范围为8.5至38.7 Gy（中位数为17 Gy）。检查的参数包括年龄、糖尿病、肥胖、炎症性肠病或憩室炎病史、既往手术史、血红蛋白水平、FIGO分期、EBR剂量、技术和每日剂量分割、HDR治疗次数和A点总剂量、近距离放疗对膀胱和直肠的最大剂量以及A点的累积剂量。所有患者的中位随访时间为37个月。并发症采用内部评分系统并根据法国-意大利语词汇表（FIG）进行分级。
IB期、II期、IIIB期和IV期的5年精算生存率分别为93%、57%、46%和0%。161例患者中，11%发生中度后遗症，3.7%发生重度后遗症（FIG分级：2.5%，3.7%）。由于一些患者经历了不止一种并发症，总体发生率为13.6%和4.9%（FIG分级：3.1%，4.9%），中度并发症的5年精算率分别为14%和5%，重度肠道和泌尿生殖道并发症的5年精算率分别为2%和8%（FIG分级：3.5%，0%，2%，8%）。所有重度肠道并发症均发生在1.5年内，而泌尿系统后遗症在整个随访期间持续出现。FIGO分期与晚期后遗症显著增加相关（P = 0.015）。对其余治疗前和治疗参数的分析未发现与中度或重度后遗症有任何统计学上的显著相关性。
在我们使用HDR近距离放疗的系列研究中，并发症和生存率与其他采用低剂量率（LDR）或HDR程序的系列研究相当。在所有分析的参数中，疾病分期是单因素和多因素分析中与并发症显著相关的唯一参数。
