High dose rate 192Ir afterloading brachytherapy for cancer of the vagina
High dose rate 192Ir afterloading brachytherapy for cancer of the vagina
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DOI：
10.1259/bjr/15634046
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发表时间：
2003-10-01
影响因子：
2.6
通讯作者：
Saffle, PA
中科院分区：
文献类型：
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作者：
Kushner, DM;Fleming, PA;Saffle, PA
我们报告了近距离放射治疗阴道癌的结果，使用了Nucletron（TM）高剂量率系统的Delaminary阴道施源器（圆柱形）和Syed模板施源器（间质性）。使用线性二次（LQ）模型来确定最佳时间剂量分次方案。在包括大体肿瘤的等剂量线处确定间质剂量。在阴道表面（5例）、0.5 cm深度（5例）或1.0 cm深度（1例）确定圆柱体剂量。对于首次治疗（n = 19），8例患者使用了间质模板，11例患者使用了阴道圆柱体。11例患者接受了第二次治疗：6个模板和5个圆柱体。外照射的中位剂量（n = 15）为40.0戈伊，中位间隔23天后，在30-42小时内进行4次高剂量率近距离放射治疗（HDRB）;然后中位间隔25天，然后重复HDRB。每例患者的中位总分次HDRB剂量为23.0戈伊（范围：6.9戈伊至40.4戈伊;计算的低剂量率等效值为29.8戈伊）。肿瘤组织学包括14例鳞状细胞癌、2例腺癌、2例黑色素瘤和1例小细胞瘤。3例患者发生了早期近距离放射治疗相关并发症（腹泻、排尿困难和唇皮炎）。3例患者（15.8%）发生严重/晚期并发症，包括输尿管狭窄、疼痛性阴道坏死和小肠梗阻。这些患者中的第一个接受了2个模板，第二个是圆柱体，然后是模板和圆柱体，第三个是单个圆柱体。2年无进展生存率为39.3%（中位15.7个月），2年总生存率为66.1%（中位29.9个月）。Ir-192后装HDRB是治疗阴道癌的可行方法，具有可接受的毒性和肿瘤反应。潜在的优势包括患者偏好，圆柱体技术的门诊成本效益，以及医院人员无辐射暴露。需要长期随访以进一步评估晚期并发症，并需要更大规模的研究来证实我们的结果。
We report results of brachytherapy for carcinoma of the vagina, utilizing a Nucletron(TM) high dose rate system for Delclos Vaginal Applicators (cylinder) and Syed Template Applicators (interstitial). The linear quadratic (LQ) model was used to determine the optimum time-dose-fractionation schedules. Interstitial doses were determined at the isodose line that included gross tumour. Cylinder doses were determined either at the vaginal surface (5 cases), at 0.5 cm depth (5 cases), or at 1.0 cm depth (1 case). For the first treatment (n = 19), interstitial templates were utilized in 8 patients and vaginal cylinders in 11. 11 patients received second treatments: 6 templates and 5 cylinders. The median dose of external beam radiation (n = 15) was 40.0 Gy followed, after a median 23 day interval, by high dose rate brachytherapy (HDRB) of 4 fractions in 30-42 h; then a median interval gap of 25 days, followed by repeat HDRB. The median total fractionated HDRB dose per patient was 23.0 Gy (range: 6.9 Gy to 40.4 Gy; calculated low dose rate equivalent of 29.8 Gy). Tumour histologies included 14 squamous cell carcinomas, 2 adenocarcinomas, 2 melanomas, and I small cell turnout. Three patients experienced early brachytherapy-related complications (diarrhoea, dysuria and labial dermatitis). Three patients (15.8%) developed serious/late complications including ureteral stenosis, painful vaginal necrosis and small bowel obstruction. The first of these patients received 2 templates, the second a cylinder followed by a template and a cylinder, and the third a single cylinder. The 2 year progression-free survival was 39.3% (median 15.7 months), while the 2 year overall survival was 66.1% (median 29.9 months). Ir-192 afterloading HDRB is a feasible approach to women with vaginal cancer with acceptable toxicity and tumour response. Potential advantages include patient preference, outpatient cost-effectiveness in the case of cylinder technique, and no radiation exposure to hospital personnel. Long-term follow-up is needed to further assess late complications, and larger studies are needed to confirm our results.