Wang C J, Leung S W, Chen H C, Sun L M, Fang F M, Changchien C C, Huang E Y, Wu J M, Chen C C
Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung Hsien, Taiwan.
Int J Radiat Oncol Biol Phys. 1997 May 1;38(2):391-8. doi: 10.1016/s0360-3016(96)00624-4.
To report the treatment results and rectal/bladder complications of cervical carcinoma radically treated with high-dose-rate intracavitary brachytherapy (HDR-IC). The current policy of using three-fraction scheme was examined.
Between November 1987 and August 1990, 173 patients with cervical carcinoma were treated with curative-intent radiation therapy. Whole pelvic irradiation was administered with 10-MV X ray. Dose to the central cervix was 40-44 Gy in 20-22 fractions, following by pelvic wall boost 6-14 Gy in three to seven fractions with central shielding. 60Co sources were used for HDR-IC, and 7.2 Gy was given to Point A for three applications, 1-2 weeks apart. Duration of follow-up was 5-7.8 years.
Twenty-eight patients (16%) developed central-regional recurrences. Overall 5-year actuarial pelvic control rate was 83%. By stage, 5-year actuarial pelvic control rates were 94%, 87%, and 72% for Stages IB + IIA, IIB + IIIA, and IIIB + IVA, respectively. Thirty-one patients (18%) developed distant metastasis. Overall 5-year actuarial survival rate was 58%. By stage, 5-year actuarial survival rates were 79%, 59%, and 41% for Stages IB + IIA, IIB + IIIA, and IIIB + IVA, respectively. Sixty-six (38%) and 19 patients (11%) developed rectal and bladder complications, respectively. For rectal complication, the overall actuarial rate was 38% at 5 years. By grade, 5-year actuarial rectal complication rates were 24%, 15%, 4%, and 3% for Grades 1-4, respectively. Overall prevalence of rectal complications was 37% and 14% at 2 and 5 years, respectively. Prevalence of low-grade rectal complication (Grades 1 and 2) was dominant at 2 years (30%), but declined to 8% at 5 years. Prevalence of high-grade, severe rectal complication (Grades 3 and 4) remained steady at 2 and 5 years (7% and 6%, respectively). Five-year actuarial bladder complication was 9%. Five-year prevalence of bladder complication was 2%.
Using a three-fraction scheme, survival rate appeared comparable with the existing results of the low-dose-rate technique. The incidence of rectal complication with this scheme remained relatively high. The increased part of rectal complication was predominantly low grade. This result suggested that therapeutic gain with this scheme may not be good enough to circumvent its biologic disadvantage. Numbers of fractions >3 must be considered in future trials.
报告高剂量率腔内近距离放射治疗（HDR-IC）根治性治疗宫颈癌的疗效及直肠/膀胱并发症。对当前采用三分次方案的策略进行了研究。
1987年11月至1990年8月，173例宫颈癌患者接受了根治性放射治疗。采用10兆伏X射线进行全盆腔照射。宫颈中心剂量为40 - 44 Gy，分20 - 22次照射，随后对盆腔壁进行补充照射，剂量为6 - 14 Gy，分三至七次照射，中心部位屏蔽。采用60钴源进行HDR-IC，分三次对A点给予7.2 Gy照射，每次间隔1 - 2周。随访时间为5 - 7.8年。
28例（16%）患者出现中心区域复发。总体5年精算盆腔控制率为83%。按分期，IB + IIA期、IIB + IIIA期和IIIB + IVA期的5年精算盆腔控制率分别为94%、87%和72%。31例（18%）患者发生远处转移。总体5年精算生存率为58%。按分期计算，IB + IIA期、IIB + IIIA期和IIIB + IVA期的5年精算生存率分别为79%、59%和41%。分别有66例（38%）和19例（11%）患者出现直肠和膀胱并发症。对于直肠并发症，5年总体精算发生率为38%。按分级，1 - 4级的5年精算直肠并发症发生率分别为24%、15%、4%和3%。直肠并发症的总体发生率在2年和5年分别为37%和14%。低级别直肠并发症（1级和2级）的发生率在2年时占主导（30%），但在5年时降至8%。高级别、严重直肠并发症（3级和4级）的发生率在2年和5年时保持稳定（分别为7%和6%）。5年精算膀胱并发症发生率为9%。膀胱并发症的5年发生率为2%。
采用三分次方案，生存率似乎与低剂量率技术的现有结果相当。该方案直肠并发症的发生率仍然相对较高。直肠并发症增加的部分主要是低级别。这一结果表明，该方案的治疗增益可能不足以弥补其生物学劣势。未来试验中必须考虑照射次数大于3次的情况。
