Kuettel M R, Parda D S, Harter K W, Rodgers J E, Lynch J H
Department of Radiation Medicine, Georgetown University School of Medicine, Washington, D.C. 20007, USA.
J Urol. 1997 May;157(5):1669-71.
We developed and present our experience with high dose rate brachytherapy for treatment of carcinoma of the urethra in medically inoperable women.
Since 1991, 4 women with localized urethral cancer, medically unable to undergo resection or interstitial implantation, were treated with external beam and high dose rate intracavitary implantation rather than external beam irradiation alone. The fractionated implants were delivered with a high dose rate remote afterloader using a shielded vaginal applicator and modified urethral catheter. The urethral catheter was inserted through the lumen of a 20F Foley tube to improve depth dose. Homogeneous dose distribution was achieved and customized to the individual patient.
All high dose rate brachytherapy treatments were given at the clinic without use of sedation or anesthesia. Treatment was well tolerated, and all patients maintained voluntary urinary function and local control at 12 to 55 months after therapy. Chronic morbidity due to urethral, bladder, vaginal or rectal injury, including urethral stenosis, necrosis or fistula, was not noted. Isodose distributions were compared among this technique, interstitial implantation and external beam radiotherapy alone.
Although we prefer interstitial implantation as the boost technique for women with urethral cancer, high dose rate brachytherapy is a reasonable option for medically inoperable patients. This outpatient treatment is well tolerated, preserves voluntary urinary function and enhances quality of life.
我们开展并介绍了高剂量率近距离放射治疗医学上无法手术的女性尿道癌的经验。
自1991年以来，4例患有局限性尿道癌、医学上无法进行切除或组织间植入的女性，接受了外照射和高剂量率腔内植入治疗，而非单纯的外照射。分次植入通过高剂量率遥控后装治疗机，使用屏蔽阴道施源器和改良尿道导管进行。尿道导管通过20F Foley管的管腔插入，以提高深度剂量。实现了均匀的剂量分布并根据个体患者进行定制。
所有高剂量率近距离放射治疗均在门诊进行，无需使用镇静剂或麻醉剂。治疗耐受性良好，所有患者在治疗后12至55个月保持自主排尿功能和局部控制。未发现因尿道、膀胱、阴道或直肠损伤导致的慢性发病率，包括尿道狭窄、坏死或瘘管。比较了该技术、组织间植入和单纯外照射放疗的等剂量分布。
虽然我们更倾向于将组织间植入作为女性尿道癌的强化技术，但高剂量率近距离放射治疗对于医学上无法手术的患者是一种合理的选择。这种门诊治疗耐受性良好，保留了自主排尿功能并提高了生活质量。
