Intracavitary Combined with CT-guided Interstitial Brachytherapy for Locally Advanced Uterine Cervical Cancer: Introduction of the Technique and a Case Presentation
Intracavitary Combined with CT-guided Interstitial Brachytherapy for Locally Advanced Uterine Cervical Cancer: Introduction of the Technique and a Case Presentation
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DOI：
10.1269/jrr.10091
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发表时间：
2011-01-01
影响因子：
2
通讯作者：
Nakano, Takashi
中科院分区：
文献类型：
--
作者：
Wakatsuki, Masaru;Ohno, Tatsuya;Nakano, Takashi
我们报告了一种新的近距离放射治疗技术，包括腔内放疗和CT引导下的间质内近距离放射治疗局部晚期宫颈癌。在室内CT引导下，使用Fletcher-Suit敷料器和套管针进行高剂量率近距离放射治疗。首先，通过传统的近距离放射治疗方法，将串联和卵泡植入患者的阴道和子宫。根据临床检查和MRI/CT成像，手术放射肿瘤师决定了肿瘤内的插入位置和从卵圆形上表面起的针的深度。在CT引导下，从肿瘤内卵圆形内的阴道穹隆插入敷针。在治疗计划中，首先根据曼彻斯特系统进行串联和卵形内的停留位置和时间调整以进行优化，然后继续逐步增加针内的停留位置。最后，手动修改驻留位置和驻留重量，直到剂量-体积约束得到最佳匹配。在我们的试点案例中，通过在剂量-体积直方图上使用我们的混合方法，D90对高危临床靶区的剂量从3.5GY提高到6.1GY。直肠、膀胱和乙状结肠的D1cc分别为4.8Gy6.4Gy3.5Gy.这种方法包括先进的图像引导下的近距离放射治疗，可以安全而准确地进行。这种方法有可能增加靶点覆盖率、治疗体积和总剂量，而不会增加对危险器官的剂量。
We report a new technique of brachytherapy consisting of intracavitary combined with computed tomography (CT)-guided interstitial brachytherapy for locally advanced cervical cancer. A Fletcher-Suit applicator and trocar point needles were used for performing high-dose rate brachytherapy under in-room CT guidance. First, a tandem and ovoids were implanted into the patient's vagina and uterus by conventional brachytherapy method. Based on clinical examination and MRI/CT imaging, operating radiation oncologists decided the positions of insertion in the tumor and the depth of the needles from the upper surface of the ovoid. Insertion of the needle applicator was performed from the vaginal vault inside the ovoid within the tumor under CT guidance. In treatment planning, dwell positions and time adaptations within the tandem and ovoids were performed first for optimization based on the Manchester system, and then stepwise addition of dwell positions within the needle was continued. Finally, dwell positions and dwell weights were manually modified until dose-volume constraints were optimally matched. In our pilot case, the dose of D90 to high-risk clinical target volume was improved from 3.5 Gy to 6.1 Gy by using our hybrid method on the dose-volume histogram. D 1 cc of the rectum, bladder and sigmoid colon by our hybrid method was 4.8 Gy, 6.4 Gy and 3.5 Gy, respectively. This method consists of advanced image-guided brachytherapy that can be performed safely and accurately. This approach has the potential of increasing target coverage, treated volume, and total dose without increasing the dose to organs at risk.