Contemporary role of modern brachytherapy techniques in the management of malignant thoracic tumors.
Contemporary role of modern brachytherapy techniques in the management of malignant thoracic tumors.
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现代近距离放射治疗技术在胸部恶性肿瘤治疗中的当代作用。
DOI：
10.1002/ssu.1017
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发表时间：
2001
期刊：
影响因子：
--
通讯作者：
M. Wannenmacher
中科院分区：
文献类型：
--
作者：
Wolfgang Harms;Heinrich D. Becker;R. Krempien;M. Wannenmacher
肺癌的单独近距离放射治疗最常使用高剂量率 (HDR) 远程后装设备进行，该设备在门诊环境中的气管支气管树内进行治疗。它在晚期阶段提供出色、快速的姑息治疗，也可以选择性地用于早期阶段的治疗目的。对于表现较好的患者，分段外放射治疗 (EBRT) 比近距离放射治疗更适合作为初始治疗，因为它似乎可以适度提高生存率，并提供更持久的姑息治疗。对于肿瘤位于中心且疾病范围有限的患者，外部和腔内照射的结合可以提供治疗选择。术中近距离放射治疗可以补充不完全切除、不可切除或因医学原因无法手术的患者的标准辅助治疗，并有可能改善选定病例的局部控制。由于该疾病的罕见性，腔内近距离放射治疗在气管肿瘤治疗方案中的作用尚未明确。腔内近距离放射治疗后致命性出血的风险似乎与肿瘤定位和分数大小相关，但在大多数情况下，致命性出血是由局部疾病的进展引起的。使用远距离施药器可以将放射源集中定位，防止将高接触剂量输送到粘膜，并可以降低毒性。保乳手术和辅助 EBRT 后间质近距离放射治疗的标准技术是使用低剂量率 (LDR) 近距离放射治疗，但也可以通过脉冲剂量率 (PDR) 或 HDR 技术来应用。需要进行前瞻性试验来比较不同的增强技术和适应症，以更准确地定义最适合间质近距离放射治疗的患者亚组。使用近距离放射治疗模具对胸壁局部复发进行再照射是有效的，并且提供了较高的局部控制率和可接受的毒性。
Sole brachytherapy for carcinoma of the lung is most often performed using high-dose-rate (HDR) remote afterloading equipment, which delivers the treatment within the tracheobronchial tree in an outpatient setting. It provides excellent, rapid palliation in advanced stages, and can also be used selectively for curative intent in early stages. In better-performance patients, fractionated external beam radiation therapy (EBRT) is preferred to brachytherapy as an initial treatment because it appears to provide a modest gain in survival, and more sustained palliation. In patients with centrally located tumors and limited extent of disease, the combination of external and endoluminal irradiation enables curative treatment options. Intraoperative brachytherapy may complement standard adjuvant treatment in incompletely resected, unresectable, or medically inoperable patients, and has the potential to improve local control in selected cases. Due to the rarity of the disease, the role of endoluminal brachytherapy in the treatment regimen of tracheal neoplasms is not yet clearly defined. The risk of fatal bleeding after endoluminal brachytherapy appears to be correlated with tumor localization and fraction size, but in the majority of cases fatal bleeds are caused by progression of local disease. The use of a distanceable applicator provides a central positioning of the source, prevents the delivery of high-contact doses to the mucosa, and may reduce toxicity. The standard technique for interstitial brachytherapy after breast-conserving surgery and adjuvant EBRT is the use of low-dose-rate (LDR) brachytherapy, but it may also be applied by means of pulsed-dose-rate (PDR) or HDR techniques. Prospective trials comparing different boost techniques and indications are needed to define more precisely the subgroup of patients who are most suitable for interstitial brachytherapy. Reirradiation of chest wall local recurrences using brachytherapy molds is effective and provides a high local control rate with acceptable toxicity.
DOI：
10.1016/s0022-5223(19)39149-4
发表时间：
1983-09
期刊：
The Journal of thoracic and cardiovascular surgery
影响因子：
--
作者：
D. Cortese;P. Pairolero;E. Bergstralh;L. Woolner;Uhlenhopp Ma;J. Piehler;D. Sanderson;P. E. Bernatz;David E. Williams;W. Taylor;Payne Ws;R. Fontana
通讯作者：
D. Cortese;P. Pairolero;E. Bergstralh;L. Woolner;Uhlenhopp Ma;J. Piehler;D. Sanderson;P. E. Bernatz;David E. Williams;W. Taylor;Payne Ws;R. Fontana