摘要
The purpose of this study was to analy ze dosimetric factors of radiation -induced severe bowel c omplications among patients with cervical cancer.We re viewed 297patients of stage IB -IVA cervical cancer manage d by curative -in-tent radiotherapy from May 1993thro ugh December 1997.Whole -pelvic irradiation of extern al beam radiation ther-apy(EBRT)(34.2-48.6Gy /19-27fractions)was delivered to all patients.Two hundr ed and three patients received additional bilateral para metrial boost(3.6-18Gy /2-10fractions).High dose -rate(HDR)intracavi-tary brachytherapy(ICBT),16-24Gy /5fractions toPoint A,was given after external irradiation.Cumulative rectal biologically effective dose(CRBED)at rectal refer-ence point was determined by summation of EBRT and ICBT component.The 5-year incidences of Grade 3-4enterocolitis and proctitis were 10%and 7%,respective-ly.Both complications were associa ted with external parametrial dose(PMD)and CRBED.Interaction of CRBED and PMD was noted in multivaria te analysis of enterocolitis(P<0.001)and proctitis(P<0.001).In CRBED≥100Gy 3 group,PMD was an independent factor in enterocolitis(P =0.010)and proctitis(P =0.039).In PMD≥54Gy group,CRBED was an independent factor in enterocolitis(P =0.003)-and proctitis(P =0.036).Patients with both PMD≥54Gy and CRBED≥100Gy 3 had higher incidence of 5-year enterocolitis(26%)(P<0.001)and proctitis(17%)(P<0.001)than other dose groups.Radiation -i nduced severe bowel complications are association on both high PMD and high CRBED.We do not suggest both external PMD≥54Gy and CRBED≥100Gy 3 for treatment of cervical cancer due to unacceptably high incidence o f severe bowel com-plications.
The purpose of this study was to analy ze dosimetric factors of radiation -induced severe bowel c omplications among patients with cervical cancer.We re viewed 297patients of stage IB -IVA cervical cancer manage d by curative -in-tent radiotherapy from May 1993thro ugh December 1997.Whole -pelvic irradiation of extern al beam radiation ther-apy(EBRT)(34.2-48.6Gy /19-27fractions)was delivered to all patients.Two hundr ed and three patients received additional bilateral para metrial boost(3.6-18Gy /2-10fractions).High dose -rate(HDR)intracavi-tary brachytherapy(ICBT),16-24Gy /5fractions toPoint A,was given after external irradiation.Cumulative rectal biologically effective dose(CRBED)at rectal refer-ence point was determined by summation of EBRT and ICBT component.The 5-year incidences of Grade 3-4enterocolitis and proctitis were 10%and 7%,respective-ly.Both complications were associa ted with external parametrial dose(PMD)and CRBED.Interaction of CRBED and PMD was noted in multivaria te analysis of enterocolitis(P<0.001)and proctitis(P<0.001).In CRBED≥100Gy 3 group,PMD was an independent factor in enterocolitis(P =0.010)and proctitis(P =0.039).In PMD≥54Gy group,CRBED was an independent factor in enterocolitis(P =0.003)-and proctitis(P =0.036).Patients with both PMD≥54Gy and CRBED≥100Gy 3 had higher incidence of 5-year enterocolitis(26%)(P<0.001)and proctitis(17%)(P<0.001)than other dose groups.Radiation -i nduced severe bowel complications are association on both high PMD and high CRBED.We do not suggest both external PMD≥54Gy and CRBED≥100Gy 3 for treatment of cervical cancer due to unacceptably high incidence o f severe bowel com-plications.
