CT引导下宫颈复发癌挽救性组织间插植近距离治疗剂量学分析

目的 CT引导下组织间插植近距离治疗宫颈复发癌患者的新方法,分析其剂量学优势。方法 16例接受过手术和术后辅助性体外放疗的宫颈复发癌患者接受了CT引导下金属针植入的组织间插植治疗。给予高危临床靶区(HR-CTV)6 Gy 6次剂量。评价本次近距离治疗肿瘤靶区HR-CTV D90;之前的体外照射和本次近距离治疗累加的膀胱、直肠及乙状结肠D2 cm³值。结果 HR-CTV D90的平均值为(52.5±3.3) Gy。膀胱、直肠、乙状结肠累加D2 cm³分别为(85.6±5.8)、(71.6±6.4)、(69.6±5.9) Gy。每次近距离治疗金属针的平均使用量为(6.1±1.5)。实际1年OS、LC分别为81%、69%。结论 CT引导下组织间插植近距离治疗对宫颈复发癌具有很好的DVH参数和较小的并发症,或许临床是可行的,但其远期临床结果尚待进一步观察。

Dosimetric analysis of CT-guided salvage interstitial brachytherapy for recurrent cervical cancer

Objective To analyze the dosimetric advantages of CT-guided interstitial brachytherapy for recurrent cervical cancer. Methods A total of 16 patients with recurrent cervical cancer after radical surgery and adjuvant external beam radiotherapy received interstitial brachytherapy with CT-guided implantation of metal needles. The high-risk clinical target volume (HR-CTV) was given 36 Gy in 6 fractions. D90 for HR-CTV in the brachytherapy and the cumulative D2 cm³ values for the bladder, rectum, and sigmoid colon in the previous external beam radiotherapy and the brachytherapy were analyzed. Results The mean D90 value for HR-CTV was 52.5±3.3 Gy. The cumulative D2 cm³ values for the bladder, rectum, and sigmoid colon were 85.6±5.8 Gy, 71.6±6.4 Gy, and 69.6±5.9 Gy, respectively. The mean number of metal needles was 6.1±1.5 in each brachytherapy. The actual 1-year overall survival and local control were 81% and 69%, respectively. Conclusions CT-guided interstitial brachytherapy for recurrent cervical cancer shows good dose-volume histogram parameters and few complications, so it may be clinically feasible. However, its long-term clinical efficacy needs further observation.