High-dose rate brachytherapy (HDRB) for primary or recurrent cancer in the vagina.
High-dose rate brachytherapy (HDRB) for primary or recurrent cancer in the vagina.
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DOI：
10.1186/1748-717x-3-7
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发表时间：
2008-02-13
期刊：
影响因子：
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通讯作者：
Sukumvanich P
中科院分区：
文献类型：
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作者：
Beriwal S;Heron DE;Mogus R;Edwards RP;Kelley JL;Sukumvanich P
本研究的目的是评价HDR近距离放射治疗初发或复发阴道癌的疗效。2000年至2006年，18例初发或复发阴道癌患者接受了近距离放射治疗(HDRB)。其中6例为原发性阴道癌(II~IVA期)，12例为单纯阴道复发(原发子宫颈4例，外阴1例，子宫内膜7例)。有5名患者曾接受过盆腔放射治疗。除1例患者外，其余患者均接受外照射，中位剂量为45Gy31.2~55.8Gy.5例患者使用阴道圆柱体置入HDRB，13例患者使用改良Syed-Nesblett模板进行间质置入。放射治疗剂量为18.75Gy5次/次，每日2次。中位随访期为18个月(6~66个月)。除1例(94%)外，其余患者均获完全缓解(CR)。在17例获得CR的患者中，1例局部复发，3例全身性复发，中位时间为6个月(范围6-22个月)。全组2年精算局部控制率为88%，病因特定生存率为82.5%。在亚组分析中，初发阴道癌的粗略局部控制率为100%，有复发组的局部控制率为100%，无放疗复发组的局部控制率为67%。2例晚期3级或更高的发病率(1例直肠阴道瘘和1例慢性阴道溃疡导致出血)。这两名患者都曾接受过放射治疗。我们的小系列研究表明，HDRB对于初发或复发的阴道癌是有效的。在这种情况下，接受原发疾病治疗的患者和没有事先接受放射治疗的复发疾病患者从HDRB中受益最大。既往接受过放射治疗的患者的抢救率较低，发生重大并发症的风险较高。正在进行更多的患者和随访，以确定这种方法的长期疗效。
The purpose of this study was to evaluate the efficacy of HDR brachytherapy for primary or recurrent vaginal cancer. Between the years 2000 to 2006, 18 patients with primary or recurrent vaginal cancer were treated with brachytherapy (HDRB). Six patients had primary vaginal cancer (stage II to IVA) while 12 were treated for isolated vaginal recurrence (primary cervix = 4, vulva = 1 and endometrium = 7). Five patients had previous pelvic radiation therapy. All except one patient received external beam radiation therapy to a median dose of 45 Gy (range 31.2–55.8 Gy). The HDRB was intracavitary using a vaginal cylinder in 5 patients and interstitial using a modified Syed-Nesblett template in 13 patients. The dose of interstitial brachytherapy was 18.75 Gy in 5 fractions delivered twice daily. The median follow-up was 18 months (range 6–66 months). Complete response (CR) was achieved in all but one patient (94%). Of these 17 patients achieving a CR, 1 had local recurrence and 3 had systemic recurrence at a median time of 6 months (range 6–22 months). The 2-year actuarial local control and cause-specific survival for the entire group were 88% and 82.5%, respectively. In subset analysis, the crude local control was 100% for primary vaginal cancer, 100% for the group with recurrence without any prior radiation and 67% for group with recurrence and prior radiation therapy. Two patients had late grade 3 or higher morbidity (rectovaginal fistula in one patient and chronic vaginal ulcer resulting in bleeding in one patient). Both these patients had prior radiation therapy. Our small series suggests that HDRB is efficacious for primary or recurrent vaginal cancer. Patients treated with primary disease and those with recurrent disease without prior irradiation have the greatest benefit from HDRB in this setting. The salvage rate for patients with prior radiation therapy is lower with a higher risk of significant complications. Additional patients and follow-up are ongoing to determine the long-term efficacy of this approach.