definitive treatment

确定性治疗
  • 文章类型: Case Reports
    宫颈癌仍然是美国的主要健康挑战,特别是在低社会经济和非洲裔美国人的人口中。密西西比州的人口统计学在这一高风险人群中占相对较高的比例。外束放射治疗(EBRT)结合同步化疗,然后进行近距离放射治疗是IB3至IVA宫颈癌治疗的金标准。可以说,近距离放射治疗是该治疗过程中最重要的组成部分。护理研究(PCS)模式和其他最近的研究表明,近距离放射治疗不能被传统或图像引导的EBRT忽略或替代。在过去的十年中,图像引导近距离放射治疗(IGBT)的使用日益广泛。研究已经确立了IGBT优于基于点的近距离放射治疗的优越性。与CT相比,MRI与优越的软组织定义相关,并且正在成为新的护理标准。妇科团体EuropéendeCuriethesérapie和欧洲放射治疗和肿瘤学会[(GYN)GEC-ESTRO]建议将剂量规定为高风险临床目标体积(HR-CTV)。该体积包括近距离放射治疗时存在的残留肿瘤,子宫颈,和扫描中看到的任何灰色区域。(GYN)GEC-ESTRO已显示,在<50天内递送>8500cGy的剂量导致骨盆对照(PC)增加约10%,疾病特异性生存,和总生存期(OS)与历史对照相比。正常组织毒性也与历史对照相当或更好。这个剂量,在保持正常组织约束的同时,只有通过基于MRI的靶向引导的混合腔内/间质(IC/IS)针设备才能实现。密西西比大学医学中心(UMMC)已启动基于MRI的颈椎近距离放射治疗计划,迄今已治疗了18例患者;我们的经验证实了上述发现。在这份报告中,我们建议,MRI引导是必要的,并且需要混合IC/IS针装置以达到足够的剂量覆盖率.
    Cervical cancer remains a major health challenge in the United States (US), especially among the low socioeconomic and African American populations. The demographics of Mississippi constitute a relatively high percentage of this high-risk population. External beam radiation therapy (EBRT) combined with concurrent chemotherapy and followed by brachytherapy is the gold standard of treatment for stage IB3 through IVA cervical cancer. Arguably, brachytherapy is the most important component of this treatment process. Patterns of Care studies (PCS) and other more recent studies have shown that brachytherapy cannot be omitted or replaced by conventional or image-guided EBRT. The last decade has witnessed the expanding use of image-guided brachytherapy (IGBT). Studies have established the superiority of IGBT over point-based brachytherapy. MRI is associated with superior soft tissue definition compared with CT and is emerging as the new standard of care. The Gynaecological Groupe Européen de Curiethérapie and the European Society for Radiotherapy and Oncology [(GYN) GEC-ESTRO] have recommended that the dose be prescribed to the high-risk clinical target volume (HR-CTV). This volume includes residual tumor present at the time of brachytherapy, the cervix, and any gray areas seen on the scan. The (GYN) GEC-ESTRO has shown that a dose of >8500 cGy delivered in <50 days results in an approximate 10% increase in pelvic control (PC), disease-specific survival, and overall survival (OS) compared to historical controls. The normal tissue toxicity is comparable or better than historical controls as well. This dose, while maintaining normal tissue constraints, may only be achievable with a hybrid intracavitary/interstitial (IC/IS) needle device guided by MRI-based targeting.  The University of Mississippi Medical Center (UMMC) has initiated an MRI-based cervical brachytherapy program and has treated 18 patients to date; our experience confirms the above findings. In this report, we propose that MRI guidance is necessary and a hybrid IC/IS needle device is required to achieve adequate dose coverages.
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  • 文章类型: Journal Article
    BACKGROUND: Merkel cell carcinoma (MCC) is an uncommon radiosensitive, neuroendocrine malignancy. Treatment often involves surgery; however, older, sicker patients may not be candidates for an operation. Institutions have published data favoring the role of definitive radiotherapy for macroscopic locoregional disease.
    OBJECTIVE: Our objective was to report the outcome of patients treated with definitive radiotherapy.
    METHODS: We performed a systematic review of Medline, PubMed, and Embase databases for reported cases or series of definitive radiotherapy for macroscopic locoregional MCC.
    RESULTS: The mean radiation dose did not significantly differ between primary and regional sites (48.7 ± 13.2 vs 49.4 ± 10.1 Gy, P = .74). The rate of recurrence was calculated on the basis of the site of disease (11.7%) and per patient (14.3%). Recurrence was significantly more likely to occur at regional than at primary irradiated sites (16.3% vs 7.6%, P = .02). There was no association between radiotherapy dose and incidence of recurrence or nonrecurrence; primary (42.7 ± 23 vs 49.3 ± 11.8 Gy, P = .197) and regional (48.6 ± 10 vs 49.5 ± 10.3 Gy, P = .77).
    CONCLUSIONS: A limitation of this report is that most publications were retrospective; heterogeneity was present in the size of MCC and in radiotherapy details.
    CONCLUSIONS: Definitive radiotherapy for locoregional macroscopic MCC was found to confer clinically meaningful local and regional in-field control.
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