■近距离放射治疗始终是妇科癌症治疗中确定性和辅助治疗的基石。由于近距离放射治疗的快速脱落特性,目标获得高剂量和低剂量到附近的正常器官,从而增加肿瘤控制概率。
■本研究旨在使用串联和圆柱体作为近距离放射治疗器评估宫颈癌的局部控制和毒性。
■该研究于2014年1月至2018年12月在一家三级保健医院进行。31名符合我们设定的IB3-IVA临床分期标准的患者,绩效状态选择东部肿瘤协作组0-2。所有患者最初均接受外束放射治疗,然后在完成外束放射治疗(EBRT)后接受高剂量率腔内近距离放射治疗。在三个疗程中将18-21Gy的剂量递送至残留疾病,每个疗程之间间隔1周。剂量以这样的方式进行优化,即处于危险中的器官(OAR),即膀胱和直肠接受的剂量在其耐受水平内。使用5.0版不良事件通用术语标准连续监测患者的急性和晚期毒性,并通过成像进行局部控制。使用SPSS20.0版进行统计分析(SPSSInc.,芝加哥,伊利诺伊州,美国)用于评估结果。连续变量表示为平均值±标准偏差,分类变量被总结为频率和百分比。
■在31名患者中,5人(16.1%)经历了由EBRT引起的1级皮肤变化,1(3.2%)具有1级G.I.T毒性,1例(3.2%)在近距离放射治疗后出现1级辐射诱发的阴道粘膜炎。在6-8周的随访中,所有患者的影像学检查均未显示疾病证据.随访3个月时,1例(3.2%)患者患有2级和3级(9.7%)的放射性直肠炎,患有1级和1级(3.2%)的放射性膀胱炎,患有2级膀胱炎。随访6个月时,1例(3.2%)为1级,1例(3.2%)为2级,1例(3.2%)为3级放射性直肠炎。随访3个月时,29例(93.5%)患者无疾病证据,而2人(6.5%)在影像学上有残留病。随访6个月时,所有患者均无病.在12个月的随访中,26例(83.9%)患者无病,1例(3.2%)局部复发,2例(6.5%)有远处转移,而2人(6.5%)已过期。在24个月的随访中,26例患者无病。急性和晚期毒性与标准近距离放射治疗器治疗宫颈癌相似。83.87%的病例实现了局部控制。2年生存率为93.5%。
■我们观察到串联和圆柱形涂药器是可接受的用于腔内近距离放射治疗的涂药器。除此之外,它既安全又简单;毒性和局部控制与宫颈癌近距离放射治疗中使用的其他标准涂抹器相似。然而,由于OARs的限制,无法在所有患者中获得A点所需的剂量处方.此外,需要长期随访才能看到失败的模式,无复发生存率,总生存率,以及治疗患者的长期毒性。
UNASSIGNED: Brachytherapy always remains a keystone in the treatment of gynecological carcinoma for both definitive and adjuvant treatments. Due to the rapid fall-off nature of brachytherapy, the target gets a high dose with a low dose to the normal organs nearby and thereby increasing the tumor control probability.
UNASSIGNED: This study aims at the evaluation of local control and toxicities in the carcinoma of the cervix using tandem and cylinder as brachytherapy applicator.
UNASSIGNED: The study was conducted between January 2014 and December 2018 in a tertiary care hospital. Thirty-one patients who fulfilled our set criterion of Clinical stage IB3-IVA, Performance status Eastern Cooperative Oncology Group 0-2 were selected. All patients were treated initially with external beam radiotherapy and later by high dose rate
intracavitary brachytherapy after completion of external beam radiation therapy (EBRT). A dose of 18-21 Gy was delivered to the residual disease in three sessions with a 1-week interval between each session. The dose was optimized in such a way that the organs at risk (OAR), namely bladder and rectum received doses within their tolerance levels. The patients were continuously monitored using Common Terminology Criteria for Adverse Events version 5.0 for both acute and late toxicities and by imaging for local control. Statistical analysis using SPSS Version 20.0 (SPSS Inc., Chicago, Illinois, USA) was used to evaluate the results. Continuous variables were expressed as mean ± standard deviation, and categorical variables were summarized as frequencies and percentages.
UNASSIGNED: Out of the 31 patients, 5 (16.1%) experienced radiation-induced Grade 1 skin changes which were due to EBRT, 1 (3.2%) had Grade 1 G. I. T toxicity, 1 (3.2%) had Grade 1 radiation-induced vaginal mucositis after brachytherapy. At 6-8-week follow-up, all the patients showed no evidence of disease on radiological imaging. At 3 months of follow-up, 1 (3.2%) patient had radiation-induced proctitis of Grades 2 and 3 (9.7%) had radiation-induced cystitis of Grades 1 and 1 (3.2%) had Grade 2 cystitis. At 6 months of follow-up, 1 (3.2%) had Grade 1, 1 (3.2%) had Grade 2, and 1 (3.2%) had Grade 3 radiation-induced proctitis. At 3 months of follow-up, 29 (93.5%) patients had no evidence of disease, while 2 (6.5%) were having residual disease on imaging. At 6 months of follow-up, all the patients were disease-free. At 12 months of follow-up, 26 (83.9%) patients were disease-free, 1 (3.2%) had local recurrence, 2 (6.5%) had distant metastasis, and 2 (6.5%) had expired. At 24 months of follow-up, 26 patients were disease-free. Acute and late toxicities were similar to those used in the treatment of carcinoma cervix by standard brachytherapy applicators. Local control was achieved in 83.87% of cases. Two-year survival was 93.5%.
UNASSIGNED: We observed that the tandem and cylinder applicator is an acceptable applicator to be used for
intracavitary brachytherapy. It is safe and simple besides this; the toxicities and local control are similar to the other standard applicators used in brachytherapy in carcinoma cervix. However, the required dose prescription to point A was not possible in all the patients due to limitations of OARs. Furthermore, long-term follow-up is needed to see the patterns of failure, recurrence-free survival, overall survival, and long-term toxicities in the treated patients.