Long-term results of high-dose rate intracavitary brachytherapy for squamous cell carcinoma of the uterine cervix
Long-term results of high-dose rate intracavitary brachytherapy for squamous cell carcinoma of the uterine cervix
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作者：
Nakano, T;Kato, S;Arai, T
背景作者进行了一项长期随访研究，以评价高闭合率腔内近距离放射治疗（HDR-ICBT）治疗宫颈癌的疗效和远期毒性。从1968年至1986年，1148例IB至IVB期宫颈鳞状细胞癌患者（根据国际妇产科联合会进行分期）接受了外照射放疗（EBRT）和HDR-ICBT联合治疗。对于早期疾病的患者，20戈瑞（戈伊）的EBRT被输送到整个骨盆，随后是24戈伊/4次HDR-ICBT和30戈伊的中心屏蔽EBRT。对于晚期患者，给予20-40戈伊全盆腔EBRT，随后给予24戈伊/4次ICBT和30-10戈伊中心屏蔽EBRT。总治疗时间约为6周。在存活者中，随访率为98%，中位随访时间为22年。IB期疾病患者的10年盆腔肿瘤控制率为93%，II期疾病患者为82%，III期疾病患者为75%。IB期疾病患者的10年总体和病因特异性生存率分别为74%和89%，II期疾病患者为52%和74%，III期疾病患者为42%和59%。10年主要并发症的精算发生率在直肠乙状结肠为4.4%，膀胱为0.9%，小膀胱为3.3%。本研究的结果表明，根据作者的方案，EBRT和HDR-ICBT联合治疗宫颈癌的结局与传统低剂量率近距离放射治疗相当，晚期并发症的发生率可接受。(C)2004年美国癌症协会。
BACKGROUND. The authors performed a long-term follow-tip study to evaluate the efficacy and late toxicity of high-close rate intracavitary brachytherapy (HDR-ICBT) for cervical carcinoma.METHODS. From 1968 to 1986, 1148 patients with Stage IB to IVB squamous cell carcinoma of the cervix (staging was performed according to the International Federation of Gynecology and Obstetrics) were treated with a combination of external beam radiotherapy (EBRT) and HDR-ICBT. For patients with early-stage disease, 20 gray (Gy) of EBRT was delivered to the whole pelvis, followed by 24 Gy/4 fractions of HDR-ICBT and 30 Gy of central-shielding EBRT. For patients with advanced-stage disease, 20-40 Gy of whole pelvic EBRT was administered, followed by 24 Gy/4 fractions of ICBT and 30-10 Gy of central-shielding EBRT. The overall treatment time was approximately 6 weeks. Among survivors, the follow-up rate was 98% and the median follow-up duration was 22 years.RESULTS. The 10-year pelvic tumor control rates were 93% for patients with Stage IB disease, 82% for patients with Stage II disease, and 75% for patients with Stage III disease. The 10-year overall and cause-specific survival rates were 74% and 89% for patients with Stage IB disease, 52% and 74% for patients with Stage II disease, and 42% and 59% for patients with Stage III disease, respectively. The 10-year actuarial rates of major complications were 4.4% in the rectosigmoid colon, 0.9% in the bladder, and 3.3% in the small intestines.CONCLUSIONS. The results of the current study suggest that the combination of EBRT and HDR-ICBT according to the authors' protocol provided outcomes that were comparable to those of the conventional low-dose rate brachytherapy with acceptable rates of late complications in the treatment of cervical carcinoma. (C) 2004 American Cancer Society.