Computed Tomography-Guided Interstitial Brachytherapy for Locally Advanced Cervical Cancer: Introduction of the Technique and a Comparison of Dosimetry With Conventional Intracavitary Brachytherapy.
Computed Tomography-Guided Interstitial Brachytherapy for Locally Advanced Cervical Cancer: Introduction of the Technique and a Comparison of Dosimetry With Conventional Intracavitary Brachytherapy.
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DOI：
10.1097/igc.0000000000000929
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发表时间：
2017-05
期刊：
影响因子：
--
通讯作者：
Wang TJ
中科院分区：
文献类型：
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作者：
Liu ZS;Guo J;Zhao YZ;Lin X;Zhang BY;Zhang C;Wang HY;Yu L;Ren XJ;Wang TJ
我们提出了一种三维计算机断层引导间质近距离放射治疗局部晚期宫颈癌的新技术，为临床治疗提供了更有利的方法。间质BT采用子宫串联针与金属针结合的穿刺器；在实时三维计算机断层扫描引导下徒手插入针头。对28例体外束放射治疗后肿瘤体积大和/或参数扩展（肿瘤大小> ~ 5cm）的患者进行了IS BT治疗，研究了IS BT治疗的剂量学结果，包括高危临床靶体积（HR-CTV）的总剂量（外束放疗和高剂量率BT） D90和危险器官（OARs）的D2cc，并与30例接受常规腔内（IC） BT治疗的患者组进行了比较IC BT和IS BT组HR-CTV分别为76.9±5.7 Gy和88.1±3.3 Gy。此外，在IS BT组中，85.7%的患者在HR-CTV为87 Gy及以上时获得D90，而在IC BT组中，只有6.7%的患者在HR-CTV为87 Gy及以上时获得D90。IC BT组膀胱、直肠和乙状结肠的D2cc分别为84.7±6.8、69.2±4.2和67.8±4.5 Gy， IS BT组为81.8±6.5、66.8±4.0和64.8±4.1 Gy。平均针数为6.9±1.4根，每根IS BT平均深度为2.9±0.9 mm，间质BT仅伴有轻微并发症。与传统的IC BT相比，IS BT技术对大体积肿瘤（bbb50 - 5cm）的剂量-体积直方图参数更好，局部晚期宫颈癌急性并发症风险可接受，临床可行。
We present a new technique of 3-dimensional computed tomography–guided interstitial (IS) brachytherapy (BT) for locally advanced cervical cancer, offering a more advantageous clinical treatment approach. Interstitial BT was performed using an applicator combining uterine tandem and metal needles; needles were inserted freehand under real-time 3-dimensional computed tomography guidance. Twenty-eight patients with bulky tumors and/or parametrial extension (tumor size > 5 cm) after external beam radiotherapy received IS BT. Dosimetric outcomes of the IS BT including the total dose (external beam radiotherapy and high dose-rate BT) D90 for the high-risk clinical target volume (HR-CTV) and D2cc for the organs at risk (OARs) were investigated and compared with a former patient group consisting of 30 individuals who received the conventional intracavitary (IC) BT. The mean D90 values for HR-CTV in the IC BT and IS BT groups were 76.9 ± 5.7 and 88.1 ± 3.3 Gy, respectively. Moreover, 85.7% of the patients received D90 for HR-CTV of 87 Gy or greater in the IS BT group, and only 6.7% of the patients received D90 for HR-CTV of 87 Gy or greater in the IC BT group. The D2cc for the bladder, rectum, and sigmoid were 84.7 ± 6.8, 69.2 ± 4.2, and 67.8 ± 4.5 Gy in the IC BT group and 81.8 ± 6.5, 66.8 ± 4.0, and 64.8 ± 4.1 Gy in the IS BT group. The mean number of needles was 6.9 ± 1.4, with a mean depth of 2.9 ± 0.9 mm for each IS BT. Interstitial BT was associated with only minor complications. The IS BT technique resulted in better dose-volume histogram parameters for large volume tumors (>5 cm) compared with the conventional IC BT and acceptable risk of acute complications in locally advanced cervical cancer and is clinically feasible.