Image-based brachytherapy for cervical cancer

Cervical cancer is the third most common cancer in women worldwide; definitive radiation therapy and concurrent chemotherapy is the accepted standard of care for patients with node positive or locally advanced tumors > 4 cm. Brachytherapy is an important part of definitive radiotherapy shown to improve overall survival. While results for two-dimensional X-ray based brachytherapy have been good in terms of local control especially for early stage disease, unexplained toxicities and treatment failures remain. Improvements in brachytherapy planning have more recently paved the way for three-dimensional image-based brachytherapy with volumetric optimization which increases tumor control, reduces toxicity, and helps predict outcomes.Advantages of image-based brachytherapy include:improved tumor coverage(especially for large volume disease), decreased dose to critical organs(especially for small cervix), confirmation of applicator placement, and accounting for sigmoid colon dose. A number of modalities for image-based brachytherapy have emerged including: magnetic resonance imaging(MRI),computed tomography(CT), CT-MRI hybrid, and ultrasound with respective benefits and outcomes data. Forpractical application of image-based brachytherapy the Groupe Europeen de Curietherapie-European Society for Therapeutic Radiology and Oncology Working Group and American Brachytherapy Society working group guideline serve as invaluable tools, additionally here-in we outline our institutional clinical integration of these guidelines. While the body of literature supporting image-based brachytherapy continues to evolve a number of uncertainties and challenges remain including: applicator reconstruction, increasing resource/cost demands, mobile four-dimensional targets and organs-at-risk, and accurate contouring of "grey zones" to avoid marginal miss. Ongoing studies, including the prospective EMBRACE(an international study of MRI-guided brachytherapy in locally advanced cervical cancer) trial, along with continued improvements in imaging, contouring, quality assurance, physics, and brachytherapy delivery promise to perpetuate the advancement of image-based brachytherapy to optimize outcomes for cervical cancer patients.

Californium-252 neutron brachytherapy combined with external pelvic radiotherapy plus concurrent chemotherapy for cervical cancer: a retrospective clinical study

Background:Cervical cancer is the sixth most common cancer in Chinese women.A standard treatment modal?ity for cervical cancer is the combination of surgery,chemotherapy,external?beam radiotherapy and intracavitary brachytherapy.The aim of this study was to retrospectively assess the long?term treatment outcomes of patients with cervical cancer who were treated with californium?252 neutron brachytherapy combined with external?beam radio?therapy plus concurrent chemotherapy.Methods:We retrospectively analyzed the medical records of 150 patients with primary stages IB?IVB cervical cancer who received neutron brachytherapy combined with external?beam radiotherapy concurrently with cisplatin chemo?therapy.All patients were followed up.Using an actuarial analysis,patient outcomes and treatment?related adverse effects were evaluated and compared.Results:The median overall survival(OS)was 33.2 months.The 3?year progression?free survival rates for patients with stages I–II,III,and IV diseases were 81.0%(68/84),65.0%(39/60),and 0%(0/6),respectively;the 3?year OS rates were 90.5%(76/84),85.0%(51/60),and 16.7%(1/6),respectively.Vaginal bleeding was controlled within the median time of4.0 days.One month after treatment,97.3%of patients achieved short?term local control.The local recurrence rates for patients with stages I–II,III,and IV disease were 4.8%(4/84),11.7%(7/60),and 33.3%(2/6),respectively,and the occurrence rates of distant metastasis were 16.7%(14/84),25.0%(15/60),and 100.0%(6/6),respectively.Cancer stage,tumor size,and lymph node metastasis were identified as prognostic risk factors,but only lymph node metastasis was found to be an independent prognostic factor.The most common adverse effects during treatment were grades 1 and 2 irradiation?related proctitis and radiocystitis.Conclusion:For patients with cervical cancer,neutron brachytherapy combined with external?beam radiotherapy plus concurrent chemotherapy produces a rapid response and greatly improves local control and long?term survival rates with tolerable adverse effects.

Dose-volume parameters and clinical outcome of CT-guided free-hand high-dose-rate interstitial brachytherapy for cervical cancer

Currently, image-based 3-dimentional (3D) planning brachytherapy allows for a better assessment of gross tumor volume (GTV) and the definition and delineation of target volume in cervix cancer. In this study, we investigated the feasibility of our novel computed tomography (CT)-guided free-hand high-dose- rate interstitial brachytherapy (HDRISBT) technique for cervical cancer by evaluating the dosimetry and preliminary clinical outcome of this approach. Dose-volume histogram (DVH) parameters were analyzed according to the Gynecological GEC-ESTRO Working Group recommendations for image-based 3D treatment in cervical cancer. Twenty cervical cancer patients who underwent CT-guided free-hand HDRISBT between March 2009 and June 2010 were studied. With a median of 5 (range, 4-7) implanted needles for each patient, the median dose of brachytherapy alone delivered to 90% of the target volume (D90 ) was 45 (range, 33-54) Gyα/β10 for high-risk clinical target volume (HR-CTV) and 30 (range, 20-36) Gyα/β10 for intermediate-risk clinical target volume (IR-CTV). The percentage of the CTV covered by the prescribed dose (V100 ) of HR-CTV with brachytherapy alone was 81.9%-99.2% (median, 96.7%). With an additional dose of external beam radiotherapy (EBRT), the median D90 was 94 (range, 83-104) Gyα/β10 for HR-CTV and 77 (range, 70 -87) Gyα/β10 for IR-CTV; the median dose delivered to 100% of the target volume (D100 ) was 75 (range, 66-84) Gyα/β10 for HR-CTV and 65 (range, 57-73) Gyα/β10 for IR-CTV. The minimum dose to the most irradiated 2 cc volume (D2cc ) was 73-96 (median, 83) Gyα/β3 for the bladder, 64-98 (median, 73) Gyα/β3 for the rectum, and 52-69 (median, 61) Gyα/β3 for the sigmoid colon. After a median follow-up of 15 months (range, 3 -24 months), two patients experienced local failure, and 1 showed internal iliac nodal metastasis. Despite the relatively small number of needles used, CT-guided HDRISBT for cervical cancer showed favorable DVH parameters and clinical outcome.

Image-Based Brachytherapy in Cervical Cancer: Review and Experiences in Faculty of Medicine, Chiang Mai University

Cervical cancer is the one of the most common cancer in female patients inThailand. Radiotherapy has the role for the treatment of cervical cancer by postoperative, radical and palliative treatments. For radical radiotherapy, the combination of external beam radiation therapy and brachytherapy will be used to increase the tumor dose to curative goal. With the new development of medical images (Computed tomography (CT), Magnetic Resonance Imaging (MRI) or Ultrasonography (US)), the treatment with brachytherapy will be developed from point-based to volume-based concepts. Many studies reported the benefit of image-based brachytherapy over conventional brachytherapy and clinical benefit of using image-based brachytherapy in the treatment of cervical cancer.

Attitudes and Practices Contributing to Vaginal Stenosis in Women with Cervical Cancer Following Brachytherapy at Cancer Diseases Hospital in Lusaka, Zambia. A Cross Sectional Study

Background: Vaginal stenosis is an important adverse effect of brachytherapy for cervicalcancer. This study aimed to determine attitudes and practices contributing to vaginal stenosis following brachytherapy at the Cancer Diseases Hospital in Lusaka—Zambia. Methods: An analytical cross-sectional study design was employed, where 163 respondents were randomly selected after meeting inclusion criteria. A researcher-administered questionnaire was used to collect data and SPSS version 25 was used for data analysis. Results: Out of the 163 women enrolled in this study, 42.3% had developed vaginal stenosis while 57.7% did not with age range 15 - 60+ years. 76% exhibited good practices to measures against vaginal stenosis while majority (93.9%) of the respondents demonstrated poor attitudes towards measures to prevent the condition. Women with poor practices versus good practices (OR = 1.07, CI = 0.52 - 2.21, p = 0.855), poor attitudes versus good attitudes (aOR = 1.28, CI = 0.29 - 5.71, p = 0.746) and those employed versus unemployed (aOR = 1.76, CI = 0.73 - 4.27, p = 0.210) had increased odds of vaginal stenosis. However, these increasing effects were not significant at 5% level of significance. Although length of brachytherapy showed no significant effect independently, the odds of having vaginal stenosis were over 2 times higher for women who had been on brachytherapy between 6 and 12 months compared to those on brachytherapy for less than 6 months (OR = 2.45, CI = 1.03 - 5.82, p = 0.042). Conclusions: Failure to practice recommended measures and poor attitudes towards therapy contributes to vaginal stenosis. Efforts should be channeled towards overcoming religious, traditional, cultural and personal impediments contributing to vaginal stenosis in women with cervical cancer receiving brachytherapy.

The Experience of Pain and Anxiety in Cervical Cancer Patients Undergoing Multiple Fraction High-Dose Rate Brachytherapy: A Prospective Observational Study

Purpose: To evaluate the anxiety and pain levels of cervical cancer patients undergoing intracavitary multifraction high-dose rate (HDR) brachytherapy, as part of a process to develop guidelines for quality patient-centered care. Methods: Cervical cancer patients (n = 31) undergoingmultiple fraction HDR brachytherapy treatment at the National Institute of Oncology in Rabat (Morocco) completed ratings of pain and anxiety intensity using 11-point verbal analog scales, at 6 key time points over 2 brachytherapy insertion procedures and 4 brachytherapy fractions. Women were evaluated for psychological status at baseline before starting the brachytherapy process using the Hospital Anxiety and Depression Scale (HADS). Scores were grouped as follows: 0 - 7 = normal, 8 - 10 = borderline, 11 - 21 = abnormal. Factors that could affect anxiety levels such as education level, relationship status, number of pregnancies and prior surgical history were documented. Results: Between July and August 2020, 31 women with a median age of 49.6 years were evaluated (range: 27 - 70). The HADS score identified depression in 5 patients (16.1%) and anxiety in 12 patients (38.7%). Throughout both treatment procedures, anticipatory anxiety was reported, with a maximum intensity in the operating room during spinal anesthesia (3.23 ± 1.7) and during applicator insertion (2.97 ± 2.4). Moderate-to-severe anxiety scores were reported in 25.8% and 22.6% of patients respectively. Level of education showed a significant correlation with anxiety scores (p = 0.027). Pain increased significantly during the procedure (p ± 1.4) and applicator removal (4.74 ± 1.5) turned out to be the most painful parts of the procedure. No correlation was found between pain and anxiety levels. Conclusion: Intracavitary multifraction high-dose rate brachytherapy is associated with mild to moderate levels of pain and anxiety, although a subset of patients reported more severe symptoms and may require additional medical and psychological support, with particular emphasis on bed-rest duration and applicator removal. The development of effective interventions (both pharmacological and non-pharmacological) is needed to improve women’s experiences of brachytherapy for locally advanced cervical cancer.

Clinical study of three dimensional conformal radiotherapy combined with intracavitary brachytherapy in the treatment of cervical cancer

Objective: The aim of our study was to evaluate the outcome and complications of cervical cancer patients undergoing conventional intracavitary brachytherapy (ICBT) treated with 3D-conformal radiotherapy (3DCRT). Methods: Sixty cervical cancer patients were divided randomly into the conformal group and the conventional group. Thirty patients treated with 3D-conformal radiotherapy in the 3DCRT group, when the whole pelvic received DT 40 Gy, a planning CT scan of each patient was obtained and the second 3DCRT therapy plan was taken. Then, continued to irradiate to 50 Gy. At last, 3DCRT was boosted at local involved volumes to the total dose of 60 Gy. When 3DCRT was combined with intracavitary brachytherapy, the dose of brachytherapy to point A was 30 Gy/5 fractions. In the conventional group, after a total tumor dose of 40 Gy was delivered by the whole pelvic irradiation, the four-field technique was used to irradiate the total pelvic and regional nodes (median dose of 10 Gy), and the involved volumes were boosted to 60 Gy and the dose of brachytherapy to point A was 30 Gy-36 Gy/5-6 fractions. Moreover, both groups were combined with intracavitary brachytherapy respectively. Results: The 1, 2, 3-year survival rates for the 3DCRT group and the conventional group were 96.7%, 93.3%, 90.0% and 86.6%, 76.7%, 70% respectively (P = 0.04, P = 0.02 and P = 0.02). There was a statistically significant difference between the two groups. Compared to the two groups each other in toxic effects, except for the I-II grade rectal and bladder reaction and pelvic fibrosis which was lower in the 3DCRT group (P = 0. 007, P = 0. 006 and P = 0. 015), the side effects were similar and well tolerated in two groups. Conclusion: The all-course 3DCRT combined with intracavitary brachytherapy can be considered as an effective and feasible approach to cervical cancer and may significantly improve the survival rate and reduce the late toxicity. This new role for 3DCRT merits need further evaluation with large patient numbers and longer follows up.

Clinical Report on Californium-252 Neutron Intraluminal Brachytherapy Combined with External Irradiation for Cervical Carcinoma Treatment

OBJECTIVE To observe the curative effects and complications of californium-252 （^252Cf） neutron intraluminal brachytherapy （IBT） combined with external irradiation （El） for treatment of cervical carcinoma.METHODS From December 2000 to December 2004, 128 cases of cer vical carcinoma staged into IIA-IIIB according to the International Federation of Gynecology and Obstetrics （FIGO） standards were treated with ^252Cf neutron IBT using 8-10 Gy per fraction, once a week. The total dose at reference A point was 36-40 Gy in 4-5 fractions. From the second day after ^252Cf neutron IBT treatment, the whole pelvic cavity was treated with ^60Co y-ray El, applying 2 Gy per fraction, 4 times per week. After 20-25Gy of El, the center of the whole pelvic field was blocked with 4 cm of lead in width. The total dose of El was 45-50 Gy.RESULTS The short-term therapeutic effects were CR 95.3% and PR 4.7%. The 3 and 5-year local control rates were 93.5% and 87.9%. The overall 3-year survival rate was 87.5% and for Stages Ⅱ and Ⅲ , 90.9% and 81.5% respectively; the overall 5-year survival rate was 70% and for Stages II and III, 76.2% and 61% respectively. The rate of radiation complications was 4.7% for radiation cystitis, 7.8% for radiation proctitis, 6.3% for vagina contracture and adhesion and 5.5% for protracted radiation proctitis.CONCLUSION An combination of ^252Cf neutron IBT with El for treatment of cervical carcinoma can be well-tolerated by cervical carcinoma patients. The rate of local tumor control is high and radiation complications are few.

Experiences of Women Receiving Multifraction High Dose-Rate Brachytherapy for Cervical Cancer: A Prospective Qualitative Study

Objective: The aim of this study was to establish cervical cancer patients’ expectations and experiences during high dose-rate (HDR) intracavitary brachytherapy procedure, as part of a process to develop guidelines for quality patient-centered care. Methodology: A prospective, qualitative study with a descriptive phenomenological approach was used. Purposive sampling was carried out to recruit 31 women undergoing HDR brachytherapy for cervical cancer from June to August 2020 at the National Institute of Oncology in Rabat. Semi-structured, one-to-one interviews guided by a theme list were conducted by a female radiation oncologist in Arabic before, during and after treatment. The following aspects were discussed: expectations, experiences in the waiting room, in the treatment room, and suggestions for improvement. Data was transcribed, translated and thematic analysis performed. Results: Most of the patients felt unprepared and did not have a clear understanding of brachytherapy. Brachytherapy was a difficult experience causing fear and anxiety throughout treatment. Most women dreaded the procedure, before receiving the first treatment and even after having had one. Pain was a major problem for the participants. Some women compared this pain to childbirth, a process they preferred to brachytherapy. Patients agreed that the preventative medication received was not efficient to relieve the pain. Despite these negative experiences, patients were left with a positive outlook. Dialogue with the healthcare professionals, support from their family and fellow patients, envisaged outcomes and desires to heal were used to cope, whilst faith and spirituality gave them strength to endure the procedure. Conclusion: Women undergoing uterovaginal brachytherapy for cervical cancer experience pain and emotional distress. Providing patients with adequate information, more sensitive support during the procedure and debriefing afterwards could lessen feelings of fear and anxiety. Our findings advocate for the revision of pain management protocols. Further studies should be carried out to define patient-centered recommendations and provide quality care to this group of women.

Informational Needs in Women Undergoing Multifraction High Dose-Rate Brachytherapy for Cervical Cancer: A Prospective Qualitative Study

Objective: To identify the informational needs of Moroccan women receiving intracavitary brachytherapy for locally advanced cervical cancer as part of a process to develop guidelines for quality patient-centered care. Methodology: A prospective, qualitative study with a phenomenological approach was carried out at the Brachytherapy unit of the National Institute of Oncology in Rabat, Morocco. Purposive sampling was used to recruit 31 patients undergoing high dose-rate brachytherapy for cervical cancer from July 2020 to August 2020. Semi-structured, one-to-one interviews were conducted by a female radiation oncologist in Arabic, guided by a theme list. The interviews were translated and a thematic analysis was performed. Results: Data saturation was achieved having interviewing 31 participants, aged 27 - 70 years. Findings on patients’ informational needs were the overarching theme and form the focus of this article. The informational needs included: providing patients with disease- and treatment-related information in their home language;adequate information concerning pre-treatment preparation, possible side-effects, and sexual intercourse;and providing patients with informative material adapted to their needs as standard procedure. Conclusion: This study has identified unmet women’s informational needs during brachytherapy for cervical cancer. Providing patients with sufficient and understandable information, adequate preparation before the procedure, more sensitive support during the procedure, and debriefing afterward could lessen feelings of fear and anxiety towards treatment delivery. Guidelines with a patient-centered approach could thus be developed to be used as a tool to assist members of multidisciplinary teams in providing quality care to this group of women.

探讨经腹部超声引导宫腔管置入在不同分期宫颈癌患者三维腔内近距离放射治疗中的应用价值分析

目的:探讨经腹部超声(TAUS)引导宫腔管置入在ⅠB1~ⅣB期宫颈癌患者三维腔内近距离放射治疗(3D-ICB)中的临床应用及价值。方法:选取2023年6月—12月在贵州省人民医院收治的48例宫颈癌患者为研究对象,按宫腔管置入方法分为常规置入组(24例)和TAUS组(24例),每组均进行120次近距离放射治疗,经CT定位扫描验证两组患者的子宫隐匿穿孔率。结果:TAUS组与常规置入组比较,操作时长缩短(18.71 min vs 13.09 min,P=0.001),术中出血比例下降(19.16%vs 15.83%,P=0.611),CT扫描次数减少(121次vs 132次),隐匿性穿孔率下降(0.83%vs 5.83%,P=0.031),其中TAUS组与常规置入组各个分期穿孔率比较:ⅠB1~ⅡA2期(0.00%vs 0.00%);ⅡB~ⅢB期(0.00%vs 2.20%,P=0.343);ⅢC~ⅣB期(1.54%vs 10.00%,P=0.040)。结论:TAUS引导可以减少不同分期宫颈癌患者在3D-ICB宫腔管置入术中的时长,同时降低ⅢC~ⅣB期宫颈癌患者术后隐匿性穿孔率,为宫颈癌患者尤其是晚期患者的3D-ICB提供了一个更加安全有效的方法。

腔内联合组织间插植放疗与三维后装腔内放疗治疗局部晚期宫颈癌的疗效及剂量学参数比较

目的:对比腔内联合组织间插植放疗(intracavitary/interstitial brachytherapy,IC-ISBT)与三维后装腔内放疗(intracavitary brachytherapy,ICBT)两种方式在宫颈癌近距离治疗中的疗效与剂量学差异。方法:回顾性分析2019年01月至2021年12月于我院接受根治性放疗的61例宫颈癌患者的资料,按照治疗方法不同分为IC-ISBT组和ICBT组,对比两组近期疗效、不良反应发生率以及剂量学差异。结果:IC-ISBT组的HR-CTV D_(90%)高于ICBT组,且差异有统计学意义(P=0.026);IC-ISBT组的直肠D_(2cm^(3))、D_(1cm^(3))和膀胱D_(2cm^(3))、D_(1cm^(3))显著低于ICBT组,差异有统计学意义(P<0.05);IC-ISBT组完全缓解率明显高于ICBT组,差异有统计学意义(P<0.05);IC-ISBT组放射性肠炎发生率明显低于ICBT组,差异有统计学意义(P<0.05)。结论:IC-ISBT治疗能显著提高靶区剂量的同时降低直肠、膀胱的受量,提高肿瘤客观缓解率,降低不良反应发生率。

瑞马唑仑复合阿芬太尼抑制宫颈癌组织间插植术体动反应的半数有效剂量

目的探索瑞马唑仑复合阿芬太尼抑制宫颈癌组织间插植术体动反应的半数有效剂量(ED_(50))。方法选择辽宁省肿瘤医院2023年7月至10月宫颈癌组织间插植术患者25例,所有患者缓慢静注7μg/kg阿芬太尼,随后注射瑞马唑仑0.25 mg/kg,睫毛反射消失后进行宫颈癌组织间插植术。根据Dixon改良序贯法,若在插植过程中出现体动反应为阳性反应,下一位患者增加瑞马唑仑用量,否则为阴性反应,降低用量,剂量梯度0.01 mg/kg,直到出现7次折返,停止试验。记录入室时(T_(1))、给药完毕时(T_(2))、手术开始时(T_(3))、手术结束时(T_(4))患者心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO_(2))、脑电双频指数(BIS)水平变化及术中不良反应,采用Probit analysis概率单位回归分析计算瑞马唑仑的ED50及95%CI。结果纳入患者25例,阳性反应14例,阴性反应11例,患者术中生命体征平稳,2例一过性低血压,1例一过性心动过缓。复合阿芬太尼时,瑞马唑仑用于抑制宫颈癌组织间插植术体动反应的ED_(50)为0.28 mg/kg(95%CI:0.27~0.30 mg/kg)。结论瑞马唑仑复合阿芬太尼抑制宫颈癌组织间插植术体动反应的ED50为0.28 mg/kg(95%CI:0.27~0.30 mg/kg),患者呼吸循环稳定,镇静效果良好。

宫颈癌根治术联合新辅助化疗与腔内近距离后装放疗治疗局部晚期宫颈癌的临床效果

目的:分析宫颈癌根治术联合新辅助化疗与腔内近距离后装放疗治疗局部晚期宫颈癌(LACC)的临床效果。方法:选取2014年1月—2018年6月南通大学附属肿瘤医院收治的Ⅰb2期、Ⅱa2期LACC患者86例作为研究对象,采用随机数字表法分为观察组(n=46)和对照组(n=40)。对照组行宫颈癌根治术,观察组在术前行新辅助化疗及腔内近距离后装放疗。比较两组手术情况、术后住院时间、不良反应发生情况及生存情况。结果:观察组手术时间、术后住院时间短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05);两组输尿管尿瘘、尿潴留、肾积水、肠梗阻、下肢静脉血栓、盆腔淋巴囊肿合并感染发生率比较,差异无统计学意义(P>0.05);两组3年无进展生存率、3年总生存率、中位生存时间比较,差异无统计学意义(P>0.05)。结论:宫颈癌根治术联合新辅助化疗与腔内近距离后装放疗治疗LACC的临床效果较好,可缩短手术治疗时间、减少术中出血量,加快术后恢复,且不会增加不良反应发生风险,不影响预后效果。

Survey of current practices in the management of cervical cancer by Moroccan radiotherapists

Objective:To assess the applicability degree of the international guidelines by Moroccan radiotherapists,in order to improve the management of cervical cancer(CC),since CC is the second most common cancer for women in Morocco.Methods:This cross-sectional study was carried out using a questionnaire sent online to Moroccan radiotherapists.The questionnaire covered participants'characteristics,initial assessment and treatment preparation,techniques and indications for radiotherapy and brachytherapy,dose and indications,as well as on the protocol adopted in the intermediate stages and the location of adjuvant treatments and assessments'follow-up.Results:74 radiotherapists out of 300 have responded to the survey.Only 27.0%of practitioners reported discussing patient records systematically in a multidisciplinary consultation meeting(MCM).For the initial assessment,77.0%requested pelvic magnetic resonance imaging(MRI).It is significantly less requested in regional oncology centers(ROCs)than in university hospital centers(UHCs)or the private sector(P<0.001).Furthermore,Clinicians in ROCs do not have access to new techniques of radiotherapy.In 83.8%of cases,the most prescribed radiotherapy protocols were 45–46 Gy in 1.8–2 Gy per fraction.Three-dimensional gynaecological brachytherapy high-throughput dose guided by dosimetric scanner was available in 75.5%of structures while interstitial gynaecological brachytherapy was only available in 23%of centers.The two most prescribed dose protocols were 47 Gy and 37 Gy in 74.4%and 21.6%of cases,respectively.Finally,monitoring during the first two years was based mainly on pelvic MRI(82.2%)while PET/CT was recommended by only less than 10%.Conclusions:The findings obtained show that our radiotherapists generally comply with international guidelines for the cervical cancer management.However,they should still enhance their practices for the first staging evaluation,the use of systematic MCMs,the doses and treatment techniques used,and the follow-up evaluation.

多模态成像技术引导下组织间徒手插植近距离放射治疗宫颈癌的效果及剂量学分析

目的:探究基于多模态成像技术引导下组织间徒手插植近距离放射治疗(简称放疗)宫颈癌的效果及剂量学分析。方法:选取98例宫颈癌患者为研究对象,分为研究组49例与对照组49例,对照组予以CT图像引导组织间徒手插植近距离放疗,研究组予以实时超声联合CT图像引导组织间徒手插植近距离放疗。比较两组植入特点、疗效及放疗后90%高危临床靶区的受照射剂量(HR-CTVD90)、危及器官累积生物学剂量、并发症发生情况。结果:研究组单根针插植时间短于对照组(P<0.001),放疗后3、6个月疗效优于对照组(P<0.05)。研究组肿瘤直径5~<6 cm、6~<7 cm者HR-CTVD90均高于对照组(P<0.05)。研究组膀胱、乙状结肠、直肠累积生物学剂量均低于对照组(P<0.05),总并发症发生率低于对照组(P=0.036)。结论:多模态成像技术引导下组织间徒手插植近距离放疗对宫颈癌具有较好临床疗效,可有效减少单根针插植时间,减少并发症发生,且具有剂量学优势。

新辅助化疗联合局部热疗在局部晚期宫颈癌治疗中的疗效

目的:探讨新辅助化疗联合局部热疗在局部晚期宫颈癌治疗中的临床疗效、放疗总时间、加速器机器跳数及不良反应。方法:选取2019年9月~2022年9月桂林市人民医院40例局部晚期宫颈癌接受新辅助化疗联合局部热疗的患者作为观察组,对本组宫颈癌患者给予2个疗程TPF方案新辅助化疗,每周期给予盆腔局部深部热疗2次;同时选取单独同期放化疗40例作为对照组;分析观察组新辅助化疗联合局部热疗的疗效、两组放射治疗总时间、加速器机器跳数及两组患者的不良反应发生情况。结果:观察组新辅助化疗联合局部热疗的客观缓解率(ORR)为87.5%(35/40),其中完全缓解(CR)为30%(12/40),部分缓解(PR)为57.5%(23/40),疾病稳定(SD)为12.5%(5/40);观察组新辅助化疗联合热疗前后肿瘤最大径分别为(5.31±1.72)cm、(2.12±1.35)cm,差异有统计学意义(t=9.401,P<0.01);观察组和对照组放射治疗时间分别为(42.15±2.75)d、(53.41±6.18)d,两组比较,差异有统计学意义(t=12.398,P<0.01);观察组和对照组外照射时单次外照射加速器机器跳数分别为(1347±129.14)MU、(1556±128.61)MU两组比较,差异有统计学意义(t=3.782,P<0.01)。结论:局部晚期宫颈癌新辅助化疗联合局部热疗患者临床治疗效果显著,新辅助化疗联合热疗后腔内后装放疗能与调强外照射放疗同时进行,缩短放疗时间,单次外照射加速器机器跳数明显减少,缩短单次治疗时间,减少加速器磨损。

IMRT、3D-CRT联合腔内近距离放疗治疗宫颈癌的效果及预后比较

目的比较调强放疗(IMRT)、三维适形放疗(3D-CRT)联合腔内近距离放疗治疗宫颈癌(CC)的效果及预后。方法将86例ⅡB~ⅢB期CC患者作为本次研究对象,应用随机信封法将患者分为2组,IMRT组(n=43,采用IMRT)与3D-CRT组(n=43例,采用3D-CRT),2组均联合腔内近距离放疗治疗,比较2组近期临床治疗效果、肿瘤标志物水平、放射性不良反应以及生活质量。结果IMRT组近期疗效为83.72%,高于3D-CRT组的74.42%,但差异无统计学意义(P>0.05)。治疗后IMRT组癌类抗原125(CA-125)与癌胚抗原(CEA)水平均低于3D-CRT组(P<0.05)。IMRT组放射性并发症总发生率低于3D-CRT组(P<0.05)。治疗后IMRT组生活质量核心调查评分表(QLQC-30)各维度评分均高于3D-CRT组(P<0.05)。结论IMRT、3D-CRT联合腔内近距离放疗治疗CC短期疗效相当,但IMRT抗CC作用更强,且不良反应少,更有利于提高患者生存质量。

超润滑三腔导尿管对晚期宫颈癌后装放疗患者舒适度的影响

目的 探究超润滑三腔导管应用于晚期宫颈癌后装放疗患者对其舒适体验的影响。方法 选取2022年1月~2023年5月我院收治宫颈癌晚期患者110例,采用随机数表法分组为对照组和观察组,每组各55例。对照组应用常规三腔导尿管导尿,观察组应用超润滑三腔导尿管导尿。观察两组置入导尿管后不良事件发生率;尿道疼痛程度[视觉模拟评分(VAS)]及舒适度[宫颈癌腔内后装治疗病人舒适状况量表]。结果 置入后,观察组不良事件发生率、VAS评分低于对照组,舒适度高于对照组患者(P<0.05)。结论 晚期宫颈癌后装放疗患者,应用超润滑三腔导管可减少尿道疼痛刺激及不良护理事件发生率,改善患者舒适体验,建议临床推广使用。

New era of electronic brachytherapy

Traditional brachytherapy refers to the placement of radioactive sources on or inside the cancer tissues.Based on the type of sources,brachytherapy can be classified as radionuclide and electronic brachytherapy.Electronic brachytherapy uses miniaturized X-raysources instead of radionuclides to deliver high doses of radiation.The advantages of electronic brachytherapy include low dose to organs at risk,reduced dose to treating staff,no leakage radiation in off state,less shielding,and no radioactive waste.Most of these systems operate between 50 and 100 k Vp and are widely used in the treatment of skin cancer.Intrabeam,Xoft and Papillon systems are also used in the treatment of intra-operative radiotherapy to breast in addition to other treatment sites.The rapid fall-off in the dose due to its low energy is a highly desirable property in brachytherapy and results in a reduced dose to the surrounding normal tissues compared to the Ir-192 source.The Xoft Axxent brachytherapy system uses a 2.25 mm miniaturized X-ray tube and the source almost mimics the high dose rate Ir-192 source in terms of dose rate and it is the only electronic brachytherapy system specifically used in the treatment of cervical cancers.One of the limiting factors that impede the use of electronic brachytherapy for interstitial application is the source dimension.However,it is highly anticipated that the design of miniaturized X-ray tube closer to the dimension of an Ir-192 wire is not too far away,and the new era of electronic brachytherapy has just begun.