Dose-volume histogram parameters of high-dose-rate brachytherapy for Stage I-II cervical cancer (≤4cm) arising from a small-sized uterus treated with a point A dose-reduced plan.
Dose-volume histogram parameters of high-dose-rate brachytherapy for Stage I-II cervical cancer (≤4cm) arising from a small-sized uterus treated with a point A dose-reduced plan.
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DOI：
10.1093/jrr/rru006
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发表时间：
2014-07
影响因子：
2
通讯作者：
Nakano T
中科院分区：
文献类型：
--
作者：
Nakagawa A;Ohno T;Noda SE;Kubo N;Kuwako K;Saitoh J;Nakano T
我们研究了A点剂量减少计划在小子宫引起的I-II期宫颈癌（≤4 cm）患者中的直肠剂量节省效应和肿瘤控制。在2008年10月至2011年8月期间，19例I-II期宫颈癌（≤4 cm）患者接受了盆腔外射束放疗（EBRT）和CT引导近距离放射治疗。7例患者接受了近距离放射治疗，采用标准的源驻留位置加载，A点的分次剂量为6戈伊（常规近距离计划）。另外12名子宫靠近直肠或小肠的患者接受了近距离放射治疗，A点剂量减少以匹配直肠的D2cc，剂量限制为<6戈伊（“A点剂量减少计划”），而不是A点的6-戈伊计划（“暂定6-戈伊计划”）。将EBRT和近距离放射治疗的总剂量相加并归一化为生物等效剂量2戈伊/次（EQD 2）。常规近距离计划、暂定6-戈伊计划和A点剂量减低计划中，高危临床靶区（HR-CTV）D90的中位剂量分别为62 Gy EQD 2、80 Gy EQD 2和64 Gy EQD 2。相应的三个计划中直肠D2cc的中位剂量分别为42 GyEQD 2、62 GyEQD 2和51 GyEQD 2。中位随访期为35个月，3例患者发生1级晚期直肠并发症，无患者发生局部复发。我们的初步结果表明，CT引导下的近距离放射治疗使用个性化的A点剂量减少计划可能有助于减少晚期直肠并发症，同时保持原发性肿瘤控制。
We investigated the rectal dose-sparing effect and tumor control of a point A dose-reduced plan in patients with Stage I–II cervical cancer (≤4 cm) arising from a small-sized uterus. Between October 2008 and August 2011, 19 patients with Stage I–II cervical cancer (≤4 cm) were treated with external beam radiotherapy (EBRT) for the pelvis and CT-guided brachytherapy. Seven patients were treated with brachytherapy with standard loading of source-dwell positions and a fraction dose of 6 Gy at point A (conventional brachy-plan). The other 12 patients with a small uterus close to the rectum or small intestine were treated with brachytherapy with a point A dose-reduction to match D2cc of the rectum and <6 Gy as the dose constraint (‘point A dose-reduced plan’) instead of the 6-Gy plan at point A (‘tentative 6-Gy plan’). The total doses from EBRT and brachytherapy were added up and normalized to a biological equivalent dose of 2 Gy per fraction (EQD2). The median doses to the high-risk clinical target volume (HR-CTV) D90 in the conventional brachy-plan, tentative 6-Gy plan and point A dose-reduced plan were 62 GyEQD2, 80 GyEQD2 and 64 GyEQD2, respectively. The median doses of rectal D2cc in the corresponding three plans were 42 GyEQD2, 62 GyEQD2 and 51 GyEQD2, respectively. With a median follow-up period of 35 months, three patients developed Grade-1 late rectal complications and no patients developed local recurrence. Our preliminary results suggested that CT-guided brachytherapy using an individualized point A dose-reduced plan might be useful for reducing late rectal complications while maintaining primary tumor control.
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DOI：
10.1016/j.ijrobp.2008.09.010
发表时间：
2009-07-15
影响因子：
7
作者：
Zwahlen, Daniel;Jezioranski, John;Milosevic, Michael
通讯作者：
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影响因子：
168.9
作者：
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DOI：
10.1016/j.ijrobp.2009.05.030
发表时间：
2010-07-01
影响因子：
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影响因子：
5.7
作者：
Haie-Meder, C;Pötter, R;Wachter-Gerstner, N
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影响因子：
5.7
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