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 ...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.展开更多
Background/Aim: Immunosuppressants are now used much earlier in the course of Crohn’ s disease; however their effect on the natural history of the disease, especially on the need for surgery, is not known. The aim of...Background/Aim: Immunosuppressants are now used much earlier in the course of Crohn’ s disease; however their effect on the natural history of the disease, especially on the need for surgery, is not known. The aim of this study was to a ssess the evolution of the need for surgery in Crohn’ s disease during the last 25 years. Patients and Methods: The medical charts of 2573 patients were review ed retrospectively. The use of immunosuppressants (azathioprine or methotrexate) , the need for intestinal resection, and the occurrence of intestinal complicati ons were assessed using Kaplan- Meier analysis in five consecutive cohorts of p atients defined by the date of diagnosis of Crohn’ s disease (1978- 82; 1983- 87; 1988- 92; 1993- 97; 1998- 2002). Results: In 565 patients seen in the au thors’ unit within the first three months after diagnosis, characteristics of Crohn’ s disease at diagnosis did not differ from one cohort to another. The fi ve year cumulative probability to receive immunosuppressants increased from 0 in the 1978- 82 cohort to 0.13, 0.25, 0.25, and 0.56 in the 1983- 87, 1988- 92, 1993- 97, and 1998- 2002 cohorts, respectively (p< 0.001). Concomitantly, the cumulative risk of intestinal resection remained unchanged (from 0.35 to 0.34 a t five years; p = 0.81). The cumulative risk of developing a stricturing or a pe netrating intestinal complication remained also unchanged. Similar results were obtained in the 2008 patients seen during the same period who were referred to u s more than three months after diagnosis. Conclusion: Although immunosuppressant s have been used more frequently over the last 25 years, there was no significan t decrease of the need for surgery, or of intestinal complications of Crohn’ s disease.展开更多
文摘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.
文摘Background/Aim: Immunosuppressants are now used much earlier in the course of Crohn’ s disease; however their effect on the natural history of the disease, especially on the need for surgery, is not known. The aim of this study was to a ssess the evolution of the need for surgery in Crohn’ s disease during the last 25 years. Patients and Methods: The medical charts of 2573 patients were review ed retrospectively. The use of immunosuppressants (azathioprine or methotrexate) , the need for intestinal resection, and the occurrence of intestinal complicati ons were assessed using Kaplan- Meier analysis in five consecutive cohorts of p atients defined by the date of diagnosis of Crohn’ s disease (1978- 82; 1983- 87; 1988- 92; 1993- 97; 1998- 2002). Results: In 565 patients seen in the au thors’ unit within the first three months after diagnosis, characteristics of Crohn’ s disease at diagnosis did not differ from one cohort to another. The fi ve year cumulative probability to receive immunosuppressants increased from 0 in the 1978- 82 cohort to 0.13, 0.25, 0.25, and 0.56 in the 1983- 87, 1988- 92, 1993- 97, and 1998- 2002 cohorts, respectively (p< 0.001). Concomitantly, the cumulative risk of intestinal resection remained unchanged (from 0.35 to 0.34 a t five years; p = 0.81). The cumulative risk of developing a stricturing or a pe netrating intestinal complication remained also unchanged. Similar results were obtained in the 2008 patients seen during the same period who were referred to u s more than three months after diagnosis. Conclusion: Although immunosuppressant s have been used more frequently over the last 25 years, there was no significan t decrease of the need for surgery, or of intestinal complications of Crohn’ s disease.
