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Abstract：
OBJECTIVE: This article reports experiences with 3T magnetic resonance imaging(MRI)-guided brachytherapy (BT) for cervical cancer focusing on late side effects.
METHODS: Between June 2012 and March 2017 a total of 257 uterovaginal BT administrations were performed in 61 consecutive patients with inoperable cervical cancer. All patients were treated with BT combined with external beam radiotherapy.
RESULTS: The mean HR-CTV (high risk-clinical target volume) D90 was 87 ± 5.1 Gy equivalent dose corresponding to the conventional fractionation using 2 Gy per fraction (EQD2, range 70.7-97.9 Gy). The mean doses in OAR (organs at risk), namely rectum, sigmoid and bladder were D2 cm3rectum = 62.6 ± 6.9 Gy EQD2 (range 38.2-77.2 Gy), D2 cm3sigmoid = 66.2 ± 6.8 Gy EQD2 (43.2-78.6 Gy) and D2 cm3bladder = 75.1 ± 8.3 Gy EQD2 (58.2-92.6 Gy). There were no signs of late gastrointestinal (GI) toxicity in 49 patients, grade 3 toxicity was seen in 2 patients and grade 4 toxicity in 3 patients. There were no signs of late genitourinary (GU) toxicity in 41 patients, grade 3 toxicity was seen in 4 patients and no signs of grade 4 toxicity were seen. After the treatment, 60 patients (98.4%) achieved locoregional remission. In 54 patients (88.5%) the remission was complete, whereas in 6 patients (9.8%) remission was partial.
CONCLUSIONS: The use of 3T MRI-guided BT leads to achievement of high rates of local control with limited late morbidity as demonstrated in this series of patients.
METHODS: Between June 2012 and March 2017 a total of 257 uterovaginal BT administrations were performed in 61 consecutive patients with inoperable cervical cancer. All patients were treated with BT combined with external beam radiotherapy.
RESULTS: The mean HR-CTV (high risk-clinical target volume) D90 was 87 ± 5.1 Gy equivalent dose corresponding to the conventional fractionation using 2 Gy per fraction (EQD2, range 70.7-97.9 Gy). The mean doses in OAR (organs at risk), namely rectum, sigmoid and bladder were D2 cm3rectum = 62.6 ± 6.9 Gy EQD2 (range 38.2-77.2 Gy), D2 cm3sigmoid = 66.2 ± 6.8 Gy EQD2 (43.2-78.6 Gy) and D2 cm3bladder = 75.1 ± 8.3 Gy EQD2 (58.2-92.6 Gy). There were no signs of late gastrointestinal (GI) toxicity in 49 patients, grade 3 toxicity was seen in 2 patients and grade 4 toxicity in 3 patients. There were no signs of late genitourinary (GU) toxicity in 41 patients, grade 3 toxicity was seen in 4 patients and no signs of grade 4 toxicity were seen. After the treatment, 60 patients (98.4%) achieved locoregional remission. In 54 patients (88.5%) the remission was complete, whereas in 6 patients (9.8%) remission was partial.
CONCLUSIONS: The use of 3T MRI-guided BT leads to achievement of high rates of local control with limited late morbidity as demonstrated in this series of patients.
摘要：
目的：本文报道了3T磁共振成像（MRI）引导的近距离放射治疗（BT）治疗宫颈癌的经验，重点是晚期副作用。
方法：在2012年6月至2017年3月期间，共对61例无法手术的宫颈癌患者进行了257例子宫阴道BT给药。所有患者均采用BT联合外照射治疗。
结果：平均HR-CTV（高风险临床目标体积）D90为87±5.1Gy等效剂量，相当于使用每级分2Gy的常规分级（EQD2，范围为70.7-97.9Gy）。OAR（危险器官）中的平均剂量，即直肠,乙状结肠和膀胱为D2cm3直肠=62.6±6.9GyEQD2（范围38.2-77.2Gy），D2cm3sigmoid=66.2±6.8GyEQD2（43.2-78.6Gy）和D2cm3bankin=75.1±8.3GyEQD2（58.2-92.6Gy）。在49例患者中没有出现晚期胃肠道（GI）毒性的迹象，2例患者出现3级毒性,3例患者出现4级毒性.在41例患者中没有出现晚期泌尿生殖系统（GU）毒性的迹象，4例患者出现3级毒性,未出现4级毒性征象.治疗后,60例患者（98.4%）达到局部缓解。54例患者（88.5%）完全缓解，而6例患者（9.8%）部分缓解。
结论：使用3TMRI引导的BT可实现较高的局部控制率，并在这一系列患者中表现出有限的晚期发病率。
方法：在2012年6月至2017年3月期间，共对61例无法手术的宫颈癌患者进行了257例子宫阴道BT给药。所有患者均采用BT联合外照射治疗。
结果：平均HR-CTV（高风险临床目标体积）D90为87±5.1Gy等效剂量，相当于使用每级分2Gy的常规分级（EQD2，范围为70.7-97.9Gy）。OAR（危险器官）中的平均剂量，即直肠,乙状结肠和膀胱为D2cm3直肠=62.6±6.9GyEQD2（范围38.2-77.2Gy），D2cm3sigmoid=66.2±6.8GyEQD2（43.2-78.6Gy）和D2cm3bankin=75.1±8.3GyEQD2（58.2-92.6Gy）。在49例患者中没有出现晚期胃肠道（GI）毒性的迹象，2例患者出现3级毒性,3例患者出现4级毒性.在41例患者中没有出现晚期泌尿生殖系统（GU）毒性的迹象，4例患者出现3级毒性,未出现4级毒性征象.治疗后,60例患者（98.4%）达到局部缓解。54例患者（88.5%）完全缓解，而6例患者（9.8%）部分缓解。
结论：使用3TMRI引导的BT可实现较高的局部控制率，并在这一系列患者中表现出有限的晚期发病率。
