早期宫颈癌术后腔内近距离治疗的研究进展

宫颈癌是世界上最常见的妇科恶性肿瘤之一，每年新增病例和死亡人数绝大多数来自发展中国家，且近年来宫颈癌发病呈现出年轻化趋势，严重威胁女性健康和生命。手术治疗是早期宫颈癌的首选治疗方法之一。近距离放射治疗是宫颈癌放射治疗重要组成之一。术后病理显示存在阴道切缘阳性、近切缘因素等患者需要补充近距离放射治疗，但目前对于早期宫颈癌术后腔内近距离放射治疗适应症及具体实施方案尚未完全明确。故本文将对早期宫颈癌术后腔内近距离放射治疗适应症、放疗技术、施源器选择等方面进行综述。     

中晚期宫颈癌近距离放疗技术的研究进展

近距离放疗是中晚期宫颈癌的重要治疗手段,传统的近距离放疗计划是依据二维图像进行设计的,剂量参考点只能反映局部剂量,无法反映整个盆腔的受量情况,且二维近距离放疗无靶体积概念,未考虑肿瘤大小、形状、位置等多种因素的影响,无法对宫颈癌患者进行个体化治疗。近年来图像引导的腔内后装治疗有了长足发展,基于CT等图像引导的三维后装治疗越来越多地取代了基于X线的二维后装治疗,但仍存在较多问题需要进一步解决。本文就中晚期宫颈癌近距离放疗技术的研究进展进行综述。     

复发宫颈癌近距离治疗进展

宫颈癌是女性常见的恶性肿瘤,其主要的治疗方式是手术和放疗。宫颈癌治疗后复发率高,复发后预后较差。复发宫颈癌可分为盆腔中央型、盆腔外周型和盆腔外复发,其治疗方案取决于患者初始治疗方式和复发位置。无放疗史的患者如有手术指征,可首选手术,也可联合放化疗±近距离治疗。放疗后盆腔中央复发的患者可选择盆腔廓清术±术中放疗,但其适应...     

宫颈癌近距离腔内放疗二维治疗技术规范中国专家共识

近距离治疗是宫颈癌根治性放疗中必不可少的一部分,目前国内应用最多仍是二维近距离后装技术。为规范宫颈癌近距离腔内放疗二维治疗技术的应用与开展,中华医学会放射肿瘤治疗分会近距离治疗学组、中国医师协会放射肿瘤分会妇科肿瘤学组、中国抗癌协会近距离治疗专委会联合制定此专家共识。     

超声图像引导宫颈癌近距离治疗的研究进展

近距离治疗是宫颈癌根治性放疗不可或缺的治疗方法。随着影像技术的快速发展,三维图像引导已应用到宫颈癌近距离治疗中。三维超声凭借其优越的软组织成像特点,兼具经济、高效、便捷等优势,继CT和MRI后逐渐应用于引导宫颈癌近距离治疗。本综述通过查阅大量相关文献,总结了超声图像引导宫颈癌近距离治疗的研究进展,以供研究参考。     

超声图像引导宫颈癌近距离治疗的研究进展

近距离治疗是宫颈癌根治性放疗不可或缺的治疗方法。随着影像技术的快速发展,三维图像引导已应用到宫颈癌近距离治疗中。三维超声凭借其优越的软组织成像特点,兼具经济、高效、便捷等优势,继CT和MRI后逐渐应用于引导宫颈癌近距离治疗。本综述通过查阅大量相关文献,总结了超声图像引导宫颈癌近距离治疗的研究进展,以供研究参考。     

宫颈癌近距离放疗应用进展

近距离治疗是宫颈癌放射治疗环节中的重要组成部分.近距离放疗技术发展迅速,治疗方式多样化,近距离放疗方式包括:腔内近距离放疗、插植近距离放疗及放射性粒子植入等.本文旨在介绍腔内、插植以及放射性粒子植入的应用进展,主要回顾腔内结合插植近距离放疗的应用情况.     

盆腔插植调强近距离放疗治疗5例局部晚期宫颈癌

[目的]探讨盆腔插植调强近距离放疗在局部晚期宫颈癌中的价值。[方法]5例局部晚期原发宫颈癌患者在MRI图像及CT模拟机引导下行插植后装调强近距离放疗,肿瘤区周边剂量40Gy,2次/d,共4d完成。后装结束后1周开始外照射,盆腔淋巴结区剂量50Gy。观察近期疗效及合并症。[结果]所有患者均完成治疗计划。放疗结束后3个月复查MRI等发现CR4例,PR1例。出现1例2级肠炎。[结论]盆腔插植调强近距离放疗治疗局部晚期宫颈癌近期疗效满意,合并症可耐受。     

麻醉与镇痛在宫颈癌近距离放射治疗的应用与进展

宫颈癌近距离放射治疗是利用人体自然腔道放置施源器达到肿瘤和靶组织附近的根治性放疗。近距离放疗治疗过程中,患者通常存在施源器不耐受、疼痛、长时间制动等不适。麻醉与镇痛对于改善近距离放射治疗舒适性至关重要。目前,宫颈癌近距离治疗的麻醉和镇痛领域尚不存在最佳共识。本综述旨在介绍国内外镇静镇痛在近距离放疗中的应用与研究进展,为临床提供参考,展望其未来的发展方向。     

插植调强近距离放疗复发宫颈癌的同期对照研究

目的:探讨插植调强近距离放疗在复发宫颈癌中的价值.方法:25例盆腔复发宫颈癌患者行插植后装调强近距离放疗为实验组,选择同期行常规后装放疗的25例盆腔复发宫颈癌患者作为对照组,比较两组间的近期疗效及合并症.结果:实验组完全缓解20例,部分缓解5例,对照组完全缓解10例,部分缓解7例,稳定4例,进展4例,差异有统计学意义(P=0.005).实验组出现5例阴道直肠瘘,1例3级肠炎;对照组出现3例阴道直肠瘘,1例3级肠炎.结论:盆腔插植调强近距离放疗治疗复发宫颈癌近期疗效满意,优于常规近距离放疗,毒副反应可耐受.     

非根治剂量的体外照射配合腔内放疗加根治术治疗宫颈癌

目的 总结分析外照射配合腔内放疗加根治术治疗Ⅰb-Ⅲa期宫期癌的5年生存率和晚期并发症。方法 106例宫颈癌均行广泛性子宫切除和盆腔淋巴结清除术,其中78例行术前放疗（体外加腔内放疗,下同）,16例采用腔内放疗＋手术,12例术后放疗。外照射采用^60Co治疗机,给予合盆或盆腔四野照射,B点剂量术前放疗者为25－30Gy,术后放疗者为40－50Gy;腔内放疗采用^192Ir高剂量率后装机,A点剂量6－18Gy。结果 （1）5年生存率：Ⅰb-Ⅲa期术前放疗组为78.2%（61／78）,腔内＋手术组为68.8%（11／16）,术后放疗组为33.3%（4／12）。术前放疗组与术后放疗组相比,差异有显著性（P＜0.05）。术前放疗组中,Ⅱ期患者的5年生存率(77.6%,45／58）高于术后放疗组（1／4,P＜0.05）。（2）主要并发症：多为放射性直肠炎和膀胱炎。术前放疗组、腔内放疗＋手术组和术后放疗组的并发症发生率分别为34.6%(27/78）、31.3%（5／16）和33.3%(4/12),差异无显著性（P＞0.05）。结论 非根治量的体外照射配合腔内放疗加根治术治疗宫颈癌,可提高Ⅰb-Ⅲa期患者总的5年生存率和Ⅱ期患者的5年生存率,晚期并发症发生率差异无显著性。     

Places respectives de la radiothérapie et de la chirurgie dans les cancers du col utérin

The treatment of cervical cancer patients relies on surgery and radiotherapy (according to the stage) and requires a multimodal discussion before any treatment to avoid adding the morbidities of each individual intervention and to optimize functional and oncological outcomes. The places of surgery and radiotherapy have been highlighted in recent international guidelines. For early stage tumors, an exclusive surgery with or without fertility sparing (according to well defined criteria) is the therapeutic standard. For tumors with risk factors (measuring more than 2 cm in size and/or presence of lymphovascular invasion) a preoperative brachytherapy can be proposed to minimize the need for postoperative external beam radiotherapy and optimize local control. For locally advanced disease, the standard treatment relies on chemoradiation followed by a brachytherapy boost. A primary paraaortic lymph node dissection may guide radiotherapy volumes and is useful to identify patients requiring a para-aortic radiotherapy. The technical evolutions of surgical approaches and technological improvement of radiotherapy and brachytherapy should be analyzed in the context of prospective studies. We review the literature on the respective places of radiotherapy and surgery for the treatment of cervical cancer.     

The role of postoperative radiotherapy in carcinoma of the endometrium

The role of adjuvant postoperative radiotherapy in endometrial carcinoma after surgery remains controversial. There is a great variation between centres in deciding when to give postoperative external beam radiotherapy and/or vaginal vault brachytherapy for patients with endometrial carcinoma. The role of pelvic and para-aortic lymphadenectomy as well as the need for postoperative radiotherapy after this type of surgical staging continue to be debated. Furthermore, the role of adjuvant chemotherapy either alone or in combination with adjuvant radiotherapy also remains to be determined. This overview discusses the role of postoperative radiotherapy in the context of surgery and other adjuvant treatments in carcinoma of the endometrium.     

Standards, options, and recommendations for the radiotherapy of patients with endometrial cancer. FNCLCC (National Federation of Cancer Campaign Centers) and CRLCC (Regional Cancer Campaign Centers)]

OBJECTIVES: To develop clinical practice guidelines according to the definitions of the Standards, Options and Recommendations project for the radiotherapy of carcinoma of the endometrium. METHODS: Data were identified by searching Medline and personal reference lists of members of the expert groups. Once the guidelines were defined, the document was submitted for review to independent reviewers, and to the medical committees of the 20 French Cancer Centres. RESULTS: The main recommendations for the radiotherapy of carcinoma of the endometrium are: 1) For grade 1 and 2 stage IA tumours, follow-up alone is standard as additional treatment. For grade 1 and 2 stage IB tumours, vaginal brachytherapy or follow-up alone are options. For grade 3, stage IB tumours and stage IC disease, there are two treatment options: external pelvic radiotherapy with a brachytherapy boost or vaginal brachytherapy. 2) Treatment for stage II disease can be preoperative when stage II disease has been suggested by a positive endometrial curettage. Postoperative vaginal brachytherapy is given for stage IIA tumours if the penetration of the myometrium is less than 50% or if the tumour is grade 1 or 2. In the case of deep penetration, or higher grade disease, or for stage IIB external radiotherapy with brachytherapy boosting must be undertaken routinely. 3) After surgery, for stage IIIA disease, either external pelvic radiotherapy or abdomino-pelvic radiotherapy is indicated, along with medical treatment in certain patients. For stage IIIB tumours, postoperative external radiotherapy with brachytherapy (if possible) should be undertaken. For stage IIIC tumours, standard treatment is external (pelvic or pelvic and para-aortic) radiotherapy followed or not by a brachytherapy boost. In case of extrauterine sites involved abdomino-pelvic irradiation is recommended. 4) Standard treatment for inoperable stage I and II disease is external radiotherapy and brachytherapy. For patients with inoperable stage III or IV disease, treatment is often symptomatic, combining external radiotherapy and medical treatment.     

宫颈癌IMRT与BT联合应用研究进展

BT是宫颈癌根治性放疗的重要组成部分。随着放疗技术不断发展,对于盆腔体外IMRT后残存肿瘤体积大、伴有宫旁浸润的宫颈癌患者,有学者提出了BT同步IMRT的治疗技术。本文回顾近年来IMRT与BT综合应用在宫颈癌治疗中的研究进展。     

影像学技术在图像引导宫颈癌近距离放射治疗中的应用

图像引导放射治疗是一种很有前途的放射治疗技术,可以提高宫颈癌患者的局部控制率,降低并发症发生率。MRI软组织分辨率高,是图像引导宫颈癌近距离放射治疗公认的金标准。CT软组织分辨率虽不及MRI,但更易识别施源器、源和源路径,在宫颈癌的放疗计划中,CT的使用率远远高于MRI。新的成像技术,如PET和MRI,改善了放疗计划中靶区的勾画,特别是PET联合CT、MRI,在功能成像方面也显得越来越重要。在病人初始分期方面,超声已经被MRI取代,但在图像引导妇科插植和腔内近距离治疗中起重要作用。本综述的目的是评估各种影像技术在图像引导宫颈癌近距离放射治疗中的应用。     

Brachytherapy for Organ and Function Preservation in Soft-Tissue Sarcomas in Adult and Paediatric Patients

Adjuvant radiotherapy is an integral component in the management of soft-tissue sarcomas. Brachytherapy is a very convenient and conformal way of delivering adjuvant radiotherapy in such tumours, which spares the surrounding normal tissue. Randomised studies have established the efficacy of brachytherapy in the adjuvant setting, with a 5-year local control of 80–85%. High dose rate, low dose rate and pulsed dose rate have shown equivalent local control, but high dose rate has gained popularity owing to patient convenience, radiation safety and flexibility in dose optimisation. Freehand insertion perioperative brachytherapy (intraoperative placement and postoperative treatment) is the most commonly used technique in soft-tissue sarcomas, with intraoperative radiotherapy and radioactive seed placement being the less commonly used techniques. Brachytherapy can be used as monotherapy or in combination with external beam radiotherapy, such as in cases of close/positive margins for safe dose escalation. Although the quantum of side-effects with external beam radiotherapy has considerably reduced with the evolution of technology and the introduction of intensity modulation (intensity-modulated radiotherapy), brachytherapy still scores better in terms of dose conformality, especially in recurrent tumours (previously irradiated) and when used to treat paediatric and geriatric patients.