Three-dimensional High Dose Rate Intracavitary Image-guided Brachytherapy for the Treatment of Cervical Cancer Using a Hybrid Magnetic Resonance Imaging/Computed Tomography Approach: Feasibility and Early Results
Three-dimensional High Dose Rate Intracavitary Image-guided Brachytherapy for the Treatment of Cervical Cancer Using a Hybrid Magnetic Resonance Imaging/Computed Tomography Approach: Feasibility and Early Results
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DOI：
10.1016/j.clon.2011.08.007
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发表时间：
2011-12-01
影响因子：
3.4
通讯作者：
Krivak, T. C.
中科院分区：
文献类型：
--
作者：
Beriwal, S.;Kannan, N.;Krivak, T. C.
目的：评价影像引导近距离放射治疗（IGBT）治疗宫颈癌的可行性和结果，使用磁共振成像（MRI）为基础的计划的第一部分，然后计算机断层扫描（CT）为基础的计划后续fractions.Materials和方法：44例宫颈癌患者进行了三维高剂量率IGBT治疗。近距离放射治疗剂量为5.0-6.0戈伊× 5次。除5名患者外，所有患者均同时接受40 mg/m2顺铂每周一次治疗（2）。所有患者均接受外照射放射治疗（EBRT），中位剂量为45戈伊，分25次。对EBRT和近距离放射治疗的高风险临床靶体积（HRCTV）和风险器官（包括直肠、膀胱和乙状结肠）的总剂量进行求和，并标准化为每次2戈伊的生物等效剂量（EQD（2））。在治疗后3个月，任何早期反应进行了评估与正电子发射断层扫描（PET）/CT imaging.Results：平均D-90为HRCTV为83.3（3.0）戈伊。膀胱、直肠和乙状结肠器官的平均2 cm（3）剂量分别为79.7（5.1）、57.5（4.4）和66.8（5.7）戈伊。除1例（2.3%）患者外，所有患者均完全缓解。在41例（93.0%）患者中进行了随访PET/CT，其中38例（92.5%）完全缓解。在PET/CT显示完全缓解的38例患者中，2例分别在6个月和8个月时局部复发。精算2年局部控制，疾病特异性和总生存率分别为88，85和86%，respectively.Conclusion：这是第一次报告的三维高剂量率IGBT用于治疗宫颈癌使用混合MRI/CT的方法。早期的结果表明，这种方法具有良好的局部控制的可行性。需要进一步的研究来评估局部控制和相关发病率的长期结果。(C)2011年皇家放射科医师学院。由爱思唯尔有限公司出版。保留所有权利。
Aims: To evaluate the feasibility and outcome of image-guided brachytherapy (IGBT) for treating cervical cancer using magnetic resonance imaging (MRI)-based planning for the first fraction followed by computed tomography (CT)-based planning for subsequent fractions.Materials and methods: Forty-four patients with cervical cancer were treated with three-dimensional high dose rate IGBT. The brachytherapy dose was 5.0-6.0 Gy x five fractions. All but five patients received concurrent weekly cisplatinum at 40 mg/m(2). All patients received external beam radiotherapy (EBRT) with a median dose of 45 Gy over 25 fractions. Total doses for the high-risk clinical target volume (HRCTV) and organs at risk, including the rectum, bladder and sigmoid, from EBRT and brachytherapy were summated and normalised to a biologically equivalent dose of 2 Gy per fraction (EQD(2)). At 3 months after therapy, any early response was assessed with positron emission tomography (PET)/CT imaging.Results: The mean D-90 for the HRCTV was 83.3 (3.0) Gy. The mean 2 cm(3) dose to the bladder, rectum and sigmoid colon organs was 79.7 (5.1), 57.5 (4.4) and 66.8 (5.7) Gy, respectively. All but one (2.3%) patient had a complete response. Follow-up PET/CT was carried out in 41(93.0%) patients, of whom 38 (92.5%) had a complete response. Of the 38 patients with a complete response on PET/CT, two had local recurrences at 6 and 8 months, respectively. Actuarial 2 year local control, disease-specific and overall survival rates were 88, 85 and 86%, respectively.Conclusion: This is the first report of three-dimensional high dose rate IGBT for the treatment of cervical cancer using a hybrid MRI/CT approach. Early results have shown the feasibility of this approach with excellent local control. Additional studies are needed to assess long-term outcomes of local control and associated morbidities. (C) 2011 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.