背景:在宫颈癌的治疗中,近距离放射治疗起着至关重要的作用。最常用的技术是腔内近距离放射治疗(ICBT)。如果ICBT在技术上不可行,或者可能导致次优剂量分布,建议使用间质性近距离放射治疗(ISBT)。通过这项研究,我们想研究妇科癌症间质近距离放射治疗的临床结果和剂量学细节。
方法:我们分析了2013年1月1日至2020年12月31日期间在我们研究所进行的妇科恶性肿瘤间质近距离放射治疗(ISBT)的临床结果和剂量学细节。
结果:共分析了42例间质近距离放射治疗(ISBT)的详细信息。37例患者患有宫颈癌,5例患者患有阴道癌。在大多数患者中,ISBT给药方案为三个部分各7Gy。D2cc至直肠,膀胱,乙状结肠和肠道为4.88Gy,5.62Gy,分别为3.57Gy和2.47Gy。平均CTV体积为129.89cc。CTV联合EBRT和ISBT的EQD2剂量为85.88Gy。ISBT对CTV的D90和D100分别占处方剂量的111.96%和68.21%。在5例(12%)患者中观察到III/IV级毒性。1年和2年的局部控制率分别为88%和85.7%。DFS在1年,2年和3年占80.7%,分别为72.3%和65.7%。操作系统在1年,2年,4年和5年分别为92.5%,65.5%,分别为59.5%和42.3%。
结论:对于需要间质性近距离放射治疗的妇科恶性肿瘤,使用MUPIT植入物进行基于CT的3D成像剂量测定是可行的选择。鉴于在毒性方面的良好临床结果,本地控制,具有可接受的GEC-ESTRO剂量测定数据的DFS和OS,如果设施可用,并且在临床情况下需要ISBT,我们建议常规使用间质近距离放射治疗.
BACKGROUND: In management of Carcinoma Cervix, Brachytherapy plays a crucial role. Most commonly used technique is Intracavitary Brachytherapy (ICBT). In cases where ICBT is not technically feasible or it may result in suboptimal dose distribution, Interstitial Brachytherapy (ISBT) is recommended. With this study we wanted to study the clinical outcome and dosimetric details of interstitial brachytherapy in gynecological cancers.
METHODS: We analysed clinicaloutcome and dosimetric details of interstitial brachytherapy (ISBT) done for gynecological malignancies in our institute during the period 1st January 2013 to 31st December 2020.
RESULTS: Total of 42 interstitial brachytherapy (ISBT) details were analysed.37 patients had Carcinoma Cervix and 5 patients had Carcinoma Vagina. In the majority of the patients, ISBT dosage schedule was three fractions 7Gy each. D2cc to rectum, bladder, sigmoid and bowel were 4.88 Gy, 5.62 Gy, 3.57 Gy and 2.47 Gy respectively. Mean CTV volume was 129.89 cc. EQD2 dose to CTV combining EBRT and ISBT dose was 85.88 Gy. D90 and D100 to CTV from ISBT were 111.96% and 68.21 % of prescribed dose respectively. Grade III/IV toxicities were seen in 5 (12%) patients. Local control rates at 1year &2 years were 88% & 85.7% respectively. DFS at 1 year, 2 years and 3 years were 80.7%, 72.3% and 65.7% respectively. OS at 1year, 2 years, 4 years and 5 years were 92.5%, 65.5%, 59.5% and 42.3% respectively.
CONCLUSIONS: 3D imagebased dosimetry with CT based planning using MUPIT implant is a feasible option for gynecological malignancies warranting interstitial brachytherapy. In view of good clinical outcomes in terms of toxicity profile, Local control, DFS and OS with acceptable GEC-ESTRO dosimetric data, we recommend routine use interstitial brachytherapy if facilities are available and in clinical situations were ISBT is indicated.