目的:报告基于CT的图像引导近距离放射治疗宫颈癌的疗效和晚期副作用(LSEs)。材料:在2008年至2014年之间,分析了100例FIGO分期IIB-IVA宫颈癌患者。患者接受盆腔放疗(45-50Gy分25次)并同时进行化疗,而平均处方EBRT剂量,包括对阳性淋巴结的初始和加强剂量,范围从54到64Gy。之后,使用基于CT的程序进行腔内(IC)或腔内/间质联合(IC/IS)近距离放射治疗,规定剂量为6或8Gy,分3-7次。结果:中位随访时间46个月。5年的地方控制,无远处转移生存率,总生存率为88.9%,81.8%,77.9%,分别。与IC相比,IC/IS近距离放射治疗改善了HR-CTVD90(p<0.01)。7名患者(7.0%)患有2级膀胱LSE,无3/4级膀胱LSE。膀胱LSE与剂量体积直方图之间没有显着关系(均p>0.05)。37名患者(37%)患有2级直肠LSE,3(3%)为3级直肠LSE。直肠D1cc,D2cc,2/3级直肠毒性患者的D5cc值显着高于0/1级患者(全部p<0.05)。没有2级及以上的小肠LSE。结论:基于CT的近距离放射治疗计划可以实现出色的局部控制,并且发病率可以接受。与IC组相比,IC/IS组的HR-CTVD90可以增加。D1cc,D2cc,和D5cc对直肠LSE均显示出良好的预测值。
Purpose: To report the efficacy and late side effects(LSEs) of CT-based image-guided brachytherapy for the treatment of cervical cancer. Materials: Between 2008 and 2014, 100 patients with FIGO stage IIB-IVA cervical carcinoma were analyzed. The patients received pelvic irradiation (45-50 Gy in 25 fractions) with concurrent chemotherapy, whereas the mean prescribed EBRT dose, including initial and boost doses to positive lymph nodes, ranged from 54 to 64 Gy. Afterwards, intracavitary(IC) or combined intracavitary/interstitial(IC/IS) brachytherapy was performed using a CT-based procedure with prescribed doses of 6 or 8 Gy in 3-7 fractions. Results: The median follow-up time was 46 months. The 5-year local control, distant metastasis-free survival, and overall survival rates were 88.9%, 81.8%, 77.9%, respectively. IC/IS brachytherapy improved the HR-CTV D90 compared with IC (p<0.01). Seven patients (7.0%) had grade 2 bladder LSEs and none had grade 3/4 bladder LSEs. There was no significant relationship between bladder LSEs and the dose-volume histogram (p>0.05 for all). Thirty-seven patients (37%) had grade 2 rectal LSEs, 3(3%) had grade 3 rectal LSE. The rectum D1cc, D2cc, and D5cc values were significantly higher in patients with grades 2/3 rectal toxicity than in those with grades 0/1 (p<0.05 for all). There was no grade 2 and above small bowel LSEs. Conclusions: CT-based brachytherapy planning can achieve excellent local control with acceptable morbidity. HR-CTV D90 can increase in the IC/IS group compared with the IC group. The D1cc, D2cc, and D5cc all showed excellent predictive values for rectal LSEs.