Int J Radiat Oncol Biol Phys 2011 Dec;81 (5): 1264-70. [IF:4.503]
Californium-252 brachytherapy combined with external-beam radiotherapy for cervical cancer: long-term treatment results.
Lei X , Qian CY , Qing Y , Zhao KW , Yang ZZ , Dai N , Zhong ZY , Tang C , Li Z , Gu XQ , Zhou Q , Feng Y , Xiong YL , Shan JL , Wang D .
Cancer Center, Research Institute of Surgery and Daping Hospital, Third Military Medical University, Chongqing, China.
重庆第三军医大学大坪医院外科研究所，中国癌症研究中心
Abstract
To observe, by retrospective analysis, the curative effects and complications due to californium-252 ((252)Cf) neutron intracavitary brachytherapy (ICBT) combined with external-beam radiotherapy (EBRT) in the treatment of cervical cancer. From February 1999 to December 2007, 696 patients with cervical cancer (Stages IB to IIIB) were treated with (252)Cf-ICBT in combination of EBRT. Of all, 31 patients were at Stage IB, 104 at IIA, 363 at IIB, 64 at IIIA, and 134 at IIIB. Californium-252 ICBT was delivered at 7-12 Gy per insertion per week, with a total dose of 29-45 Gy to reference point A in three to five insertions. The whole pelvic cavity was treated with 8-MV X-ray external irradiation at 2 Gy per fraction, four times per week. After 16-38 Gy of external irradiation, the center of the whole pelvic field was blocked with a 4-cm-wide lead shield, with a total external irradiation dose of 44-56 Gy. The total treatment course was 5 to 6 weeks. Overall survival rate at 3 and 5 years for all patients was 76.0% and 64.9%, respectively. Disease-free 3- and 5-year survival rates of patients were 71.2% and 58.4%, respectively. Late complications included vaginal contracture and adhesion, radiation proctitis, radiation cystitis, and inflammatory bowel, which accounted for 5.8%, 7.1%, 6.2%, and 4.9%, respectively. Univariate analysis results showed significant correlation of stage, age, histopathologic grade, and lymph node status with overall survival. Cox multiple regression analysis showed that the independent variables were stage, histopathologic grade, tumor size, and lymphatic metastasis in all patients. Results of this series suggest that the combined use of (252)Cf-ICBT with EBRT is an effective method for treatment of cervical cancer.
摘要：
通过回顾性研究分析锎-252中子腔内近距离腔内放射联合外放射治疗宫颈癌的疗效及并发症。自1999年2月至2007年12月，对696例IB到IIIB期的宫颈癌患者进行了锎-252腔内近距离放射联合外部束放射治疗。其中，IB期患者31例，IIA期104例，IIB期363例， IIIA期64例， IIIB期134例。每位患者每周进行一次锎-252腔内照射，单次剂量7-12 Gy，参考A点共进行三到五次总剂量为29-45 Gy的腔内照射。对整个盆腔用8 MV X线外照射，每周四次，2 Gy每部分。在经历16-38 Gy的外放疗后，用4厘米宽的铅板阻挡盆腔中心，进行总剂量44-56 Gy的外照射。整体疗程为5到6周。所有患者的3年和5年总生存率分别为76.0％和64.9％。所有患者的3 - 5年无病存活率分别为71.2％和58.4％。晚期并发症包括阴道挛缩和粘连，放射性直肠炎，放射性膀胱炎及炎症性肠病，分别占5.8％，7.1％，6.2％和4.9％。单因素分析结果显示癌症分期、年龄、病理学分级和淋巴结状态同总生存率显着相关。Cox多元回归分析显示在所有患者中独立变量为分期，病理学分级，肿瘤大小及淋巴转移。该组研究结果表明联合应用锎-252腔内近距离放射结合外放射是治疗宫颈癌的有效方法。
