妇科放疗十年回顾与展望

10-year review and prospect of gynaecological radiotherapy

近年来,影像学、计算机技术和放疗设备的进步和迭代带动了妇科恶性肿瘤整体放疗技术的革新。现代妇科放疗技术以子宫颈癌根治性放疗为代表,在体外放疗(external beam radiation therapy,EBRT)和近距离放疗(brachytherapy,BT)领域,应用图像引导的精准放疗技术,结合过程肿瘤退缩的概念,将精准放疗带到新的高度,改善了局部和盆腔控制,提高了放疗增益比,降低晚期胃肠道和泌尿道毒性。其毒性是二维时代观察到的一半。尤其对于大肿瘤者,BT的插植技术为常规技术不能达到理想计划目标的患者提供了特殊的放疗解决方案。大分割的照射技术为复发晚期患者提供无创的局部治疗方案。基于放疗的整体治疗策略的优化,包括同步化疗和辅助化疗提升了中晚期妇科恶性肿瘤的疗效。放疗技术的提升需要放疗技术的体系建设和培训,以达到规范化和同质化的治疗技术标准。

In recent years,with the advancement and iteration of imaging,computer technology,and radiotherapy equipment,it has led to the innovation of the overall radiotherapy technology for gynaecological malignancies.Modern gynaecological radiotherapy technology,represented by radical radiotherapy for cervical cancer,has applied image-guided precision radiotherapy technology in the field of external beam radiation therapy(EBRT)and brachytherapy(BT),combining with the concept of process tumour regression,which has brought the precision radiotherapy to a new height,improved local and pelvic control,enhanced radiotherapy gain ratios,and reduced late gastrointestinal and urinary tract toxicity which is half of that observed in the 2D era.Especially for those with large tumours,the BT insertion technique provides an exceptional radiotherapy solution for patients who cannot achieve the desired planning goals with conventional techniques.The irradiation technique with large segmentation provides a non-invasive local treatment option for patients with advanced recurrence.Optimisation of overall radiotherapy-based treatment strategies,including synchronous chemotherapy and adjuvant chemotherapy,has enhanced the efficacy of intermediate and advanced gynaecological malignancies.The enhancement of radiotherapy technology also requires the construction of a system of standardised radiotherapy and the necessary training to achieve homogeneous treatment standards.