宫颈癌低剂量率后装腔内放射治疗的远期疗效

目的 评价Gynatron低剂量率后装腔内治疗机的疗效。方法 总结1980年4月－1986年6月间,应用Gynatron后装机配合^60Co治疗机进行根治性放疗的136例宫颈癌,并与镭疗及高剂量率腔内后装治疗进行比较分析。结果 除5例失访外,全部患者随访超过15年,随访率96.3%（131／136）。Ⅱ、Ⅲ期的10年生存率分别为83.9%和43.2%。总10年生存率为63.5%。放射性直肠炎发生率为12.5%（17／136）,放射性膀胱炎发生率9.6%（13／136）。结论 Gynatron低剂量率后装腔内治疗系统虽然有一定局限性,但仍可获得较满意的疗效;其治疗并发症患者可以接受,放射性直肠炎、放射性膀胱炎发生率高于镭疗,低于高剂量率腔内后装放疗。     

不同方法后装治疗宫颈癌152例远期放疗反应分析

目的 :比较不同方法后装治疗宫颈癌的远期放疗反应 ,探讨各种方法的合理应用。方法 :三组后装治疗病人均采取宫腔、阴道分上的方法 ,并配合外照射治疗。A组C组参照曼彻斯特法参考点均取A点 ,A组宫腔阴道对A点剂量贡献比为 1∶1,C组宫腔阴道对A点剂量贡献比 1.5～ 2 .4∶1;B组参照巴黎方法 ,参考点均取源轴中心外 2cm处 ,宫腔阴道组织受量比为 1∶1。结果 :三组疗效基本相近 ,差异无显著性 (P >0 .0 5)。远期放疗反应以阴道粘连最为常见 ,A组 36 / 4 2 (85.71% ) ,B组 4 / 86(4 .6 5% ) ,C组 (4 .17% ) ,A组显著高于B组和C组 (P <0 .0 1) ,B组和C组差异无显著性 (P >0 .0 5)。结论 :宫颈癌腔内治疗疗效确切可靠 ,但在腔内治疗各种方法的灵活应用上有时需注意 ,如参考点的设置、宫腔阴道剂量配比等 ,在采取宫腔、阴道分上参考点均取A点时 ,应结合病变范围及机器情况调整增加宫腔阴道对A点的剂量比例 (勿取 1∶1,本院用 1.5～ 2 .4∶1) ,以减少直肠、膀胱并发症。     

Radiotherapy for carcinoma of the uterine cervix by remotely controlled afterloading intracavitary system with high-dose-rate

Between January 1978 and June 1985 seventy-nine patients with carcinoma of the uterine cervix were treated by a remotely controlled afterloading system (RALS) with high-dose-rate irradiation following external beam therapy. It was given once a week with a dose per fraction of 6 Gy to point A, 3 to 6 times, using applicators equipped with 1 Ci 60Co bead in each ovoid and two 1 Ci 60Co beads in a tandem 1 cm apart. Five-year survival rates were 85, 68, and 51 percent in Stages I, II, and III, respectively. Recurrences were noted in 12 patients (20%) with a minimum follow-up of 2 years: 4 patients in the parametrium, 2 in the central area, 5 in both the parametrium and central areas, and 5 in the para-aortic lymph node. Complications were noted in 13 patients (22%): temporary rectal bleeding in 7, stenosis of the sigmoid in 2, recto-vaginal fistula in 1, ileo-sigmoidal fistula in 1, and perforation of the intestine in 2 patients. The treatment results of the high-dose-rate schedule for RALS appear to be comparable to those of conventional low-dose-rate systems reported by others. Therefore a fraction dose of 6 Gy to point A once a week by RALS should be considered to be practical, economical, and acceptable to patients.     

High-dose-rate afterloading brachytherapy in carcinoma of the cervix: an experience of 1992 patients

Purpose: To report the results of radiation therapy in carcinoma of the cervix treated by external irradiation and high-dose-rate (HDR) intracavitary brachytherapy.

Methods and Materials: This is a retrospective analysis of 2063 patients with histologically proven carcinoma of the cervix treated by external irradiation and HDR intracavitary brachytherapy between March 1985–December 1991. The Kaplan-Meier method was used for survival and disease-free survival analysis. Late complications in the bowel and bladder were calculated actuarially.

Results: There were 71 patients who did not complete the course of irradiation so only 1992 patients were retrospectively analyzed for survival. There were 2 patients (0.1%) in Stage IA, 211 (10.2%) Stage IB, 225 (10.9%) in Stage IIA, 902 (43.7%) in Stage IIB, 14 (0.7%) in Stage IIIA, 675 (32.7%) in Stage IIIB, 16 (0.8%) in Stage IVA, and 16 (0.8%) in Stage IVB. The median follow-up time was 96 months. The actuarial 5-year disease-free survival rate was 79.5%, 70.0%, 59.4%, 46.1%, 32.3%, 7.8%, and 23.1% for Stage IB, IIA, IIB, IIIA, IIIB, IVA, and IVB respectively. The actuarial 5-year disease-free survival rate for Stage IB₁ and IB₂ squamous cell carcinoma was 88.7% and 67.0%. The actuarial 5-year overall survival rate was 86.3%, 81.1%, 73.0%, 50.3%, 47.8%, 7.8%, and 30.8% for Stage IB, IIA, IIB, IIIA, IIIB, IVA, and IVB respectively. Pattern of failure revealed 20.8% local recurrence, 18.7% distant metastases, and 4% in both. The late complication rate Grade 3 and 4 (RTOG) for bowel and bladder combined was 7.0% with 1.9% Grade 4.

Conclusion: HDR brachytherapy used in this series produced pelvic control and survival rates comparable to other LDR series.     

Results of radiotherapy alone in 581 patients with Stage II carcinoma of the uterine cervix

From January 1976 to December 1978, 581 previously untreated patients with Stage II carcinoma of the uterine cervix were treated by radiotherapy alone in nine departments of radiotherapy in France. This retrospective analysis was undertaken in an attempt to evaluate the therapeutic results and prognostically significant factors. The initial clinical staging and the therapeutic guidelines were as outlined at the U.T. M. D. Anderson Hospital in Houston; all our patients were treated by standardized protocols combining external beam irradiation and intracavitary irradiation with cesium sources. The overall locoregional control rate was 83.2%, with total disease control of 74.5%. Uncorrected actuarial survival rates are 76% at 3 years and 68% at 5 years. The incidence of severe posttherapeutic complications is 7.2%. Clinical substaging, patient's age at the time of the diagnosis, lymphangiogram findings, and tolerance to external irradiation were all found to have prognostic significance. According to those findings, the possibilities of improving the results are discussed.     

铱~(192)高剂量率后装加外照射治疗宫颈癌105例分析

目的　研究铱192 高剂量率后装加外照射治疗宫颈癌的疗效 ,并发症等。方法　前瞻性治疗 ,全盆腔外照射DT 2 5～ 3 0Gy/3周后 ,再行腔内铱192 后装治疗和盆腔四野垂直照射 :腔内每周 1次 ,A点剂量每次 5～ 7Gy ,总剂量3 0～ 3 5Gy ,盆腔四野照射 ,宫旁剂量 15～ 2 0Gy/1.5～ 2周。 结果　CR PR 10 0 % ,3年生存率Ⅱ期 89.5 % ,Ⅲ期 80 .4% ,全组 83 .8%。结论　本疗法疗效可靠 ,放射性直肠炎、膀胱炎发生率与传统方法相似 ,放射性阴道损伤略高 ,放疗中、放疗后坚持阴道冲洗非常重要。     

Postoperative radiotherapy in carcinoma of the cervix with microscopically positive resection margin

Background Patients with cervical cancer who have positive surgical resection margins after radical hysterectomy are at increased risk for local recurrence. The results of postoperative pelvic radiotherapy for cervix cancer with microscopically positive surgical resection margins were analyzed to evaluate the role of radiotherapy. Methods Between 1979 and 1992, 60 patients with cervix carcinoma were treated with postoperative radiotherapy after radical hysterectomy and pelvic lymphadenectomy because of microscopic positive vaginal (48 patients), or parametrial (12 patients) resection margins. Patients were treated with external beam radiation therapy (EBRT) alone (12 patients), or EBRT plus vaginal ovoid irradiation (VOI) (48 patients). The median follow-up period was 55 months. Results The 5-year actuarial disease-free and overall survival rates for all patients were 75% and 84%, respectively. The overall recurrence rate was 23% (14/60). Among the 48 patients with positive vaginal resection margins, 4 had pelvic recurrence (8%), and 7 had distant metastasis (15%); the recurrence rate was 21% (9/43) in those treated with EBRT and VOI, and 40% (2/5) in the EBRT-only treated group. In the 12 patients with positive parametrial margins, 3 patients (25%) had distant metastases. The most significant prognostic factor was lymph node metastasis. Complications resulting from radiotherapy occurred at a rate of 32% (19/60), and grade III complications occurred in 3 patients (5%). Conclusion Postoperative radiotherapy can produce excellent control rates in patients with microscopically positive resection margins. In patients with positive vaginal margins, whole pelvic EBRT and VOI is recommended.     

A new microwave applicator with integrated cooling system for intracavitary hyperthermia of vaginal carcinoma

An improved design of a previously described intracavitary microwave hyperthermia applicator is presented. The applicator consists of a coaxial choke antenna designed to be positioned into a perspex obturator. The antenna can be fitted in the obturator in three defined positions depending on the specific clinical situation: The selected median, paramedian or lateral position can each provide differently directed heating patterns. This feature combined with the additional axial variability of the antenna position within the obturator can lead to a highly targeted heating of tumours and a reduced risk of unwanted heating of normal tissues. Various phantom studies were conducted using both liquid and solid phantoms. The saline phantom was used to check the typical action of the choke of the antenna where it was found that the antenna choke is efficiently working resulting in a heating pattern which is dependent of the insertion depth of the antenna. The solid phantom was used to measure the typical specific absorption rate (SAR) distribution of each antenna/obturator configuration.     

~(60)Co外照射加高剂量率腔内后装放射治疗鼻咽癌长期观察

目的 :分析6 0 Co外照射加高剂量率后装腔内放射治疗鼻咽癌的长期疗效及晚期放射性并发症。材料与方法 :回顾性分析 1 981年 6月至 1 988年 1 2月采用6 0 Co外照射加高剂量率后装腔内放射治疗鼻咽癌 64例。本组病例都随访 5年以上 ,失访者作死亡统计。结果 :本组病例 5年局部控制率为 82 .8% (5 3 /64)。 5年生存率和无瘤生存率分别为 75 .0 % (4 8/64)和 68.8% (4 4 /64)。鼻咽局部复发 6例 ,远处转移 8例、鼻腔骨肉瘤者 1例。晚期放射并发症 ,鼻腔死骨形成 1例 ,软硬腭骨穿孔 4例。结论 :后装腔内放射治疗适当减少鼻咽癌外照射剂量 ,增加鼻咽腔内加量照射。适应于鼻咽早期原发肿瘤和鼻咽癌外照射后鼻咽腔内残留病灶。为了减少鼻咽腔内晚期放射性并发症值得进一步改进鼻咽施源器     

Six fractions per week of external beam radiotherapy and high-dose-rate brachytherapy for carcinoma of the uterine cervix: A phase I/II study

PURPOSE: This study evaluated the treatment results of external beam radiotherapy administered in six fractions per week and high-dose-rate (HDR) brachytherapy for the treatment of cervical cancer. METHODS AND MATERIALS: From July 2000 to July 2003, 43 patients were enrolled in this study. The patients received 45 Gy from a 10-MV photon beam using four-field box or anterior-posterior beams. Parametrial regions and the pelvic side walls were boosted with up to 50.4 Gy using a midline block. The daily fraction dose was 1.8 Gy administered in six-weekly fractions, from Monday to Saturday. HDR brachytherapy was also delivered at doses of 24 Gy to point A in six fractions twice a week. The median follow-up time was 37 months (range, 9-60 months). RESULTS: The median overall treatment time was 51 days for all patients (range, 44-62 days). Thirty-four patients (79.1%) achieved complete remission and 8 (18.6%) achieved partial remission after radiotherapy. Locoregional recurrence occurred in 5 patients (11.6%), and a distant metastasis was encountered in 6 patients (13.9%). The 3-year overall survival, locoregional, and distant metastasis-free survival rates were 74.7%, 87.8%, and 84.7%, respectively. Grade 2 and 3 late rectal complications were encountered in 3 (6.5%) and 1 (2.2%), respectively. There were no Grade 3 late bladder complications. CONCLUSIONS: Six fractions per week of external beam radiotherapy and HDR brachytherapy is an effective treatment for patients with a carcinoma of the uterine cervix and can be used as a possible alternative to concomitant chemoradiotherapy in elderly patients or in patients with co-morbidity.     

高剂量率~(192)Ir后装腔内加外照射治疗宫颈癌的远期疗效分析

目的　分析高剂量率192 Ir后装腔内加外照射治疗宫颈癌的远期疗效及并发症。方法　对12 8例Ⅱ、Ⅲ期放疗后宫颈癌进行了回顾分析。其中Ⅱ期 47例 ,Ⅲ期 81例。全盆腔外照射DT2 0Gy/ 10次 ,全盆中间挡铅 4cmDT2 0Gy～ 30Gy/ 10次～ 15次 ;后装A点剂量 48Gy～ 5 6Gy/ 6次～ 7次。 结果　 1、3、5年生存率分别为 91 6 1%、81 8%和 6 7 36 % ;Ⅱ、Ⅲ期 1、3、5年生存率无统计学差异 (P >0 .0 5 ) ;远期严重并发症的发生率 7 0 3% (9/ 12 8)。结论　高剂量率192 Ir后装腔内加外照射治疗宫颈癌疗效肯定 ,并发症少。盆腔局部复发仍是放疗失败的主要原因。     

Pretreatment apoptosis in carcinoma of the cervix correlates with changes in tumour oxygenation during radiotherapy

A relationship between hypoxia and apoptosis has been identified in vitro and in experimental tumours. The aim of this study was to investigate the relationship between apoptosis, hypoxia and the change in oxygenation during radiotherapy in human squamous cell carcinoma of the cervix. Forty-two patients with locally advanced disease underwent pretreatment evaluation of tumour oxygenation using an Eppendorf computerized microneedle electrode. Twenty-two of these patients also had a second evaluation of tumour oxygenation after receiving 40-45 Gy external beam radiotherapy. Paraffin-embedded histological sections were obtained from random pretreatment biopsies for all 42 patients. Apoptotic index (AI) was quantified by morphology on TUNEL stained sections. No correlation was found between pretreatment measures of AI and either the median pO2 (r = 0.12, P = 0.44) or percentage of values < 5 mmHg (r = -0.02, P = 0.89). A significant positive correlation was found between AI and the change in tumour oxygenation (ratio of pre:post-treatment % values < 5 mmHg) following radiotherapy (r = 0.61, P = 0.002). The lack of correlation between apoptosis and hypoxia may occur because the Eppendorf measures both acute and chronic hypoxia, and the relative ability of acute hypoxia to induce apoptosis is unknown. These results indicate that cell death via apoptosis may be a mechanism of tumour reoxygenation during radiotherapy.     

Carcinoma of the intact uterine cervix treated with radiotherapy alone: A french cooperative study: Update and multivariate analysis of prognostics factors

: To determine independent prognostic factors in a group of 1875 patients with invasive carcinoma of the intact uterine cervix treated with radiotherapy alone in a French cooperative study from 1970 to 1993.

: Patients were staged according to the UICC-FIGO and MDAH substaging. The distribution per FIGO stage was Ia-Ib: 25.5%; IIa: 29%; IIIa: 5%; IIIb: 25%, and IV: 3.5%. Ninety-two percent had squamous cell carcinoma. The maximum diameter of the clinically detectable cervical disease was less than 3 cm in 24.5% of Stages I–II and in 10% of Stages III–IV, more than 5 cm in 13.5% of Stages I–II, and in 16% of Stages III–IV. Nodal involvement was shown on lymphangiogram in 16% of Stages I–II and in 32.5% of Stages III–IV.

: 1) Univariate analysis of Stages I and II: stage, cervical disease diameter, and nodal involvement are significant prognostic factors. Five-year specific survival rate (5ySS) in 83.5% in Stage Ib, 81% in IIa and 71% in IIb. Five-year disease-free survival rate (5yDFS) is 86% in tumors less of 3 cm, 76% in tumors of 3 to 5 cm, and 61.5% in tumor larger than 5 cm. Lymphangiogram strongly influences the 5-year pelvic disease-free survival rate (5yPDFS): respectively, 90% in nonpositive lymphangiogram vs. 65% when positive. A significant drop in specific and disease-free survival is observed (10 and 14%, respectively (p = 0.04) when comparing adenocarcinoma and squamous cell carcinoma. Age is a significant prognostic factor for specific because patients aged less than 30 years old have 91% vs. about 75% for patients over 30 years (p = 0.03). 2) Univariate analysis of Stages III–IV: Stage and positive lymphagiogram are predictive factors for relapse and death. Te MDAH substaging is more reliable to predict the probability of pelvic disease-free survival in Stage III. At 5 years, the FIGO Stages IIIa and IIIb have a rather similar PDFS (65% vs. 59%). Conversely, the difference of survival rates between MDAH Stage IIIA and Stage IIIB is more demonstrative (69% vs. 47.5%). 3) Multivariate analysis (Cox P. H. R. model). Nodal involvement and stage remain significant for all three models in all stages (p < 0.0001). Age above 70 years influences specific survival for Stage I–II (p = 0.01). Tumors larger than 5 cm and adenocarcinoma also appear to be independent prognostic factors for specific and disease-free survival in Stage I–II (p = 0.05 and p = 0.005, respectively).

: The relevance of tumor size (less or greater than 4 cm) is now recognized in the 1995 revised FIGO staging in Stage Ib but unfortunately not in other stages. Tumor size per stage and nodal status should be systematically recorded to allow a better prediction of failure rates and to compare literature reports.     

Results of radiotherapy in carcinoma of cervix stages I and II: the impact of involvement of endocervix

The results of radiotherapy in carcinoma of the cervix stages I and II at the University of Missouri-Columbia (UMC) in the period between 1975 and 1980 were analyzed. The failure rate was 13/58 (22.4%). While the failure was 8% (3/36) in ectocervical cancer it was 45% (10/22) in endocervical cancer. The difference was statistically significant to a p value of 0.001. Ten of 13 failure cases (77%) had involvement of the endocervix. In endocervical carcinoma 7 of 10 (70%) of the failure cases had recurrence in para-aortic or supraclavicular nodes. The impact of age, differentiation and hemoglobin level was examined.     

National audit of the management and outcome of carcinoma of the cervix treated with radiotherapy in 1993

The aim of the study was to investigate the UK prevalence of late, severe side-effects associated with radical radiotherapy for cancer of the cervix and try to identify associated factors. All patients treated for cancer of the cervix with radical radiotherapy in 1993 were identified and retrospective case notes studied to determine mortality and severe complications occurring following treatment. Of the 55 radiotherapy departments in the UK that were treating gynaecological malignancy in 1993, 53 participated in the study. There were 1558 patients with carcinoma of the cervix receiving radical radiotherapy as part of their treatment regimen in 1993, whose patterns of treatment were assessed. The main outcome measures were the development of late severe complications as defined by the Franco-Italian Glossary and mortality. Of the patients receiving surgery and radiotherapy, 58.5% underwent Wertheim's procedure. The crude rate of late severe complications in all patients with cervical cancer treated with radical radiotherapy in 1993 was 6.1% (actuarial rate 8%) at 5 years, and only four of the 91 patients who developed complications died as a result of their morbidity. There was no significant correlation of stage, centre size, surgery or radiotherapeutic approach with late morbidity in univariate analysis. The overall survival at 5 years was 47% and was lower than that of the European data from FIGO's 1990–92 cohort, for all stages. Increasing FIGO stage was the only factor significantly associated with mortality. The absence of variables that were significantly associated with late complications may well be related to the relatively low event rate compared to the sample size. Differences in surgical treatment prior to radiotherapy and radiation technique may be confounding the comparison of outcomes. The relatively poor survival for locally advanced disease and the difficulty with which these data were collated indicates that national prospective data collection is urgently required to monitor performance and hence derive best practice.     

Primary non-Hodgkin's lymphoma of the uterine cervix: Case report of long-term survival of two patients treated with surgery and radiotherapy

Two patients with Stage 1EA primary non-Hodgkin's lymphoma of the uterine cervix were treated by surgery and radiotherapy in 1986 and 1987. On follow-up, over a period of 10 years, both are well and remain free of recurrence.     

Tissue isoantigens A,B, and H in carcinoma of the cervix uteri: Their clinical significance

A specific red cell adhesion test was done in 243 patients with carcinoma of the cervix uteri and showed the presence of isoantigens in only 27.16% of the patients with infiltrating squamous cell carcinoma. There was a gradual loss of isoantigens during the development of carcinoma. The test can be usefully employed in studying the evolution of the disease. The negativity of the test was found to increase as clinical severity of the disease increases. Also, the highest percentage (57.57%) of retained isoantigen was found in large-cell nonkeratinizing carcinoma, a well-differentiated type for the cervix. Follow-up studies suggest that the loss of antigen indicates probable metastasis and a poor prognosis.     

Results of the first prospective study of carbon ion radiotherapy for hepatocellular carcinoma with liver cirrhosis

PURPOSE: To evaluate the toxicity and antitumor effect of carbon ion radiotherapy for hepatocellular carcinoma within a Phase I-II trial. METHODS AND MATERIALS: Between June 1995 and February 1997, 24 patients with histopathologically proven hepatocellular carcinoma were treated to 15 fractions within 5 weeks in a step-wise dose-escalation study. The disease stage was Stage II in 10, IIIA in 6, and IVA in 8 patients. The Common Toxicity Criteria, Radiation Therapy Oncology Group/European Organization for the Research and Treatment of Cancer criteria, and Child-Pugh score were used to evaluate toxicity. The antitumor effect was evaluated by the tumor response, cumulative local control, and survival rates. RESULTS: During a median follow-up of 71 months (range, 63-83 months), no severe adverse effects and no treatment-related deaths occurred. The Child-Pugh score did not increase by >2 points after the start of therapy. In 78% and 75% of all patients, the score did not increase by >1 point in the early and late phase, respectively. The overall tumor response rate was 71%. The local control and overall survival rate was 92% and 92%, 81% and 50%, and 81% and 25% at 1, 3, and 5 years, respectively. CONCLUSION: Carbon ion radiotherapy appears safe and effective for patients with hepatocellular carcinoma. Additional clinical studies using a larger subject group are required to confirm the therapeutic efficacy.