Combination external beam radiotherapy and high-dose-rate intracavitary brachytherapy for uterine cervical cancer: Analysis of dose and fractionation schedule
| Autor: | Kazuhiko Ogawa, Yutaka Nagai, Sadayuki Murayama, Takafumi Toita, Koji Kanazawa, Kaoru Sakumoto, Genki Adachi, Yasumasa Kakinohana, Toshiyuki Maehama, Hidehiko Moromizato |
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| Rok vydání: | 2003 |
| Předmět: |
Adult
Cancer Research medicine.medical_treatment Brachytherapy Uterine Cervical Neoplasms Humans Medicine Radiology Nuclear Medicine and imaging External beam radiotherapy Cervix neoplasm Proctitis Aged Neoplasm Staging Aged 80 and over Radiation business.industry Cumulative dose Dose fractionation Radiotherapy Dosage Middle Aged medicine.disease High-Dose Rate Brachytherapy Radiation therapy Oncology Carcinoma Squamous Cell Female Dose Fractionation Radiation Nuclear medicine business |
| Zdroj: | International Journal of Radiation Oncology*Biology*Physics. 56:1344-1353 |
| ISSN: | 0360-3016 |
| DOI: | 10.1016/s0360-3016(03)00288-8 |
| Popis: | To determine an appropriate dose and fractionation schedule for a combination of external beam radiotherapy (EBRT) and high-dose-rate intracavitary brachytherapy (HDR-ICBT) for uterine cervical cancer.Eighty-eight patients with uterine cervical squamous cell carcinoma treated with EBRT and HDR-ICBT were analyzed. Twenty-five patients were classified as early disease (nonbulky Stage I/II, less than 4-cm diameter) and 63 patients as advanced disease (greater than 4 cm diameter or Stage IIIB) according to the American Brachytherapy Society definition. Tumor diameter was measured by MRI. Pelvic EBRT was delivered before applications of ICBT. HDR-ICBT was performed once a week, with a fraction point A dose of 6 Gy. Source loadings corresponded to the Manchester System for uterine cervical cancer. No planned optimization was done. A Henschke-type applicator was mostly used (86%). Median cumulative biologic effective dose (BED) at point A (EBRT + ICBT) was 64.8 Gy(10) (range: 48-76.8 Gy(10)) for early disease, and 76.8 Gy(10) (range: 38.4-86.4 Gy(10)) for advanced disease. Median cumulative BED at ICRU 38 reference points (EBRT + ICBT) was 97.7 Gy(3) (range: 59.1-134.4 Gy(3)) at the rectum, 97.8 Gy(3) (range: 54.6-130.4 Gy(3)) at the bladder, and 324 Gy(3) (range: 185.5-618 Gy(3)) at the vagina. Actuarial pelvic control rate and late complication rate were analyzed according to cumulative dose and calculated BED.The 3-year actuarial pelvic control rate was 82% for all 88 patients: 96% for those with early disease, and 76% for advanced disease. For pelvic control, no significant dose-response relationship was observed by treatment schedules and cumulative BED at point A for both early and advanced disease. The 3-year actuarial late complication rates (Gradeor =1) were 12% for proctitis, 11% for cystitis, and 14% for enterocolitis. There were significant differences on the incidence of proctitis (p0.0001) and enterocolitis (p0.0001), but not for cystitis by the treatment schedules and cumulative point A BED. All 4 patients treated with 86.4 Gy(10) at point A suffered both proctitis and enterocolitis. Patients with cumulative BED at rectal point ofor =100 Gy(3) had significantly higher incidence of proctitis (31% vs. 4%, p = 0.013).In view of the therapeutic ratio, cumulative BED 70-80 Gy(10) at point A is appropriate for uterine cervical cancer patients treated with a combination of EBRT and HDR-ICBT. Present results and data from other literatures suggested that cumulative BED at the rectal point should be kept below 100-120 Gy(3) to prevent late rectal complication. |
| Databáze: | OpenAIRE |
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