Kagei K, Shirato H, Nishioka T, Kitahara T, Suzuki K, Tomita M, Takamura A, Arimoto T, Matsuoka S, Mizoe J E, Sakuragi N, Fujimoto S, Miyasaka K
Department of Radiology, Hokkaido University, School of Medicine, Sapporo, Japan.
Radiother Oncol. 1998 May;47(2):207-13. doi: 10.1016/s0167-8140(97)00229-6.
The purpose of this article is to evaluate fractionated high-dose-rate (HDR) intracavitary irradiation using linear source arrangement (LSA) for patients with squamous cell carcinoma of the uterine cervix.
The subjects consisted of 217 patients (71 patients with stage II and 146 with stage III disease) who received external beam therapy (EBT) followed by fractionated HDR intracavitary irradiation using LSA between January 1980 and June 1990. In EBT, 40 Gy in 20 fractions (40 Gy/20 Fr) or 39.6 Gy/22 Fr was delivered to the whole pelvis and an additional 10 Gy/5 Fr or 10.8 Gy/6 Fr was delivered to the parametrium. The intracavitary irradiation dose was 30 Gy/6 Fr or 35 Gy/7 Fr with a daily fraction size of 5 Gy and two fractions per week. During the intracavitary treatment, most patients were treated on an out-patient basis.
Cause-specific 5-year survival rates were 77% for stage II and 50% for stage III. Pelvic failure rates were 13% for stage II and 36% for stage III. In multivariate analyses, improved cause-specific survival was significantly associated with stage II (P = 0.0003), higher pretreatment serum hemoglobin level (P = 0.0015), higher pretreatment serum total protein level (P = 0.0029), and shorter total treatment time (P = 0.0024). The rate of severe (grade 3 or 4) late complication was 2% for the rectum, 1% for the small intestine or sigmoid colon and 1% for the bladder.
Fractionated HDR intracavitary irradiation using LSA is an effective treatment for patients with uterine cervical cancer without need for hospitalization.
本文旨在评估采用线性源排列（LSA）的分次高剂量率（HDR）腔内照射治疗子宫颈鳞状细胞癌患者的疗效。
研究对象为1980年1月至1990年6月期间接受外照射放疗（EBT）后采用LSA进行分次HDR腔内照射的217例患者（71例II期患者和146例III期患者）。在EBT中，全盆腔给予20次分割的40 Gy（40 Gy/20 Fr）或22次分割的39.6 Gy/22 Fr，子宫旁组织再给予5次分割的10 Gy或6次分割的10.8 Gy。腔内照射剂量为30 Gy/6 Fr或35 Gy/7 Fr，每日分割剂量为5 Gy，每周两次。腔内治疗期间，大多数患者为门诊治疗。
II期患者的特定病因5年生存率为77%，III期患者为50%。II期患者盆腔失败率为13%，III期患者为36%。多因素分析显示，特定病因生存率的提高与II期（P = 0.0003）、较高的治疗前血清血红蛋白水平（P = 0.0015）、较高的治疗前血清总蛋白水平（P = 0.0029）以及较短的总治疗时间（P = 0.0024）显著相关。直肠严重（3级或4级）晚期并发症发生率为2%，小肠或乙状结肠为1%，膀胱为1%。
采用LSA的分次HDR腔内照射是治疗子宫颈癌患者的一种有效方法，无需住院。
