ABSTRACT
Objective:Investigate the safety and feasibility of using the new self-designed implanting applicator in vaginal three-dimensional intracavitary brachytherapy after hysterectomy for gynecological cancer, and to explore the clinical value of the self-designed implanting applicator.Methods:Sixty-two gynecological cancer patients who underwent brachytherapy in Sun Yat-sen University Cancer Center were selected in this study. Each patient received three-dimensional intracavitary brachytherapy because of the indication of postoperative radiotherapy. Each patient was treated with different types of self-designed implanting applicators according the condition of postoperative vagina,and the vaginal tube and implant needle were placed in the template according to the preset channnel. Based on the actual CT images, the high-risk clinical target volume (HR-CTV), and organs at risk were defined according to unified target area delineation criteria and then the brachytherapy plan was conducted. The prescription dose of high-risk clinical target volume (HR-CTV) was 5.5 Gy/time. The parameters such as target area, organs at risk volume and irradiated dose were evaluated by DVH diagram.Results:Sixty-two patients successfully completed brachytherapy under the guidance of self-designed implanting applicator. A total of 140 implantation treatments were performed. The total average dose of HR-CTV D90% was (575.48±22.30) cGy, the mean dose D 2cm3 of bladder, rectum and sigmoid colon were (328.69±102.71), (369.14±46.59) and (27.28±71.27) cGy, the small intestine did not drop the target area, so there was no statistics. There was statistical significance between target volume and organs at risk dose ( P<0.05). Conclusions:The new self-designed implanting applicator has obvious clinical advantages in vaginal three-dimensional intracavitary brachytherapy after hysterectomy for gynecological cancer, meets the requirements of the preset planning dose,and it is sample to operate and highly safe,which indicated a bright future of the clinical application.
ABSTRACT
Objective:To analyze the dosimetric differences between CT-guided free-hand intracavity/interstitial brachytherapy[image-guided adaptive brachytherapy (IGABT)] and conventional point-A plan (CP) in the treatment of cervical cancer.Methods:Twenty-six cervical cancer patients who received four cycles of IGABT in Sun Yat-sen University Cancer Center were enrolled in this study. Two sets of CT images were obtained before and after applicator adjustment to aid in the design of CP and IGABT plans. The high-risk clinical target volume (HRCTV), point A, and organs at risk (bladder, rectum, and sigmoid colon) were defined on CT images. CP and IGABT plans were designed on CT images. Parameter differences between CP and IGABT plans were analyzed with paired t-test and Wilcoxon test. Results:According to the coverage index (CI) of CP, plans were divided into two groups: in group A (CI≥0.90), 20 CP and corresponding IGABT plans were included, and 84 CP and corresponding IGABT plans in group B (CI<0.90). The mean volume of HRCTV and mean tumor diameter in group A were significantly smaller than those in group B (46.7 cm 3vs. 62.1 cm 3, P<0.001 and 3.1 cm vs. 4.4 cm, P<0.001). Compared with CP, IGABT significantly improved the value of D 90% in all plans and group B, whereas lowered the bladder dose. IGABT also reduced the dose of sigmoid colon in group A. IGABT significantly improved conformal index and dose homogeneity index. Conclusions:IGABT can significantly improve the target coverage, conformal index and dose homogeneity index, protect organs at risk. Compared with CP, IGABT has advantages in the treatment of patients with bulky tumor.
ABSTRACT
Objective:To evaluate the differences in the cumulative doses for cervical cancer between two different methods, and analyze the correlation between the severity of radiation proctitis and the cumulative dose of the rectum.Methods.:Clinical data of 278 patients with cervical cancer treated with radiotherapy were retrospectively analyzed. The total dose of radiotherapy was calculated by simple dose volume histogram parameter accumulation method (S-DVH group) and dose accumulation by deformation image registration (DIR group) in 49 patients with radiation proctitis. The rectal cumulative dose of the 278 patients with S-DVH was counted(D 2.0cm 3/D 1.0cm 3/D 0.1cm 3). The correlation analysis was performed by Spearman’s correlation analysis. Results:The average cumulative dose(D 90%) difference of high-risk clinical target volume (HRCTV) between the S-DVH and DIR groups was 2 Gy (EQD 2Gy)[(88.66±5.75) vs. (86.66±5.54) Gy, P<0.05], and the average cumulative dose difference(D 2.0cm 3 and D 1.0cm 3) of bladder was 2.13 Gy[(82.46±6.91) vs.(80.33±6.86) Gy, P<0.05] and 2.35 Gy[(88.46±4.37) vs.(86.11±3.93) Gy, P<0.05], and the average cumulative dose difference(D 2.0cm 3 and D 1.0cm 3) of rectum was 1.99 Gy[(72.49±5.17) vs.(70.50±5.03) Gy, P<0.05] and 2.71 Gy[(78.87±4.50) vs.(76.16±4.14) Gy, P<0.05]. The rectal cumulative dose(D 2.0cm 3/D 1.0cm 3/D 0.1cm 3) was positively associated with the grade of radiation proctitis. Conclusions:The cumulative doses differ between two groups, and are equally in an acceptable range. S-DVH method is a relatively simple method to evaluate the cumulative exposure dose. The cumulative doses of the rectum(D 2.0cm 3/D 1.0cm 3/D 0.1cm 3) can be used to predict the incidence of radiation proctitis.
ABSTRACT
Objective To compare the dosimetry and toxicities between postoperative fixed-field intensity-modulated radiotherapy (FF-IMRT) and image-guided radiation therapy/volumetric modulated arc therapy (IGRT-VMAT) for cervical cancer.Methods A total of seventy patients with stage I b-Ⅱa postoperative cervical cancer who had high risk factors,were divided into FF-IMRT (FF-IMRT group,n =35)and IGRT-VMAT (IGRT-VMAT group,n =35),to compare the difference of target dose and adverse reaction between the two groups.Results In the IGRT-VMAT group,the interfractional setup errors in the x,y,and z axes were (0.25±0.14) cm,(0.26±0.16) cm,and (0.24±0.18) cm,respectively;the intrafractional setup errors in the x,y,and z axes were (0.1±0.09) cm,(0.12±0.09) cm,and (0.11±0.09) cm,respectively;the margins in the x,y,and z axes were 0.75 cm,0.84 cm,and 0.78 cm,respectively.Under the same dosimetric conditions,the IGRT-VMAT group was superior to the FF-IMRT group in terms of conformity index,treatment time,and number of monitor units (P=0.000).The Dmean and volume receiving high-dose irradiation for the bladder,rectum,and small intestine were significantly lower in the IGRT-VMAT group than in the FF-IMRT group (P=0.000).Compared with the FF-IMRT group,the IGRT-VMAT group had a significantly reduced incidence of acute and chronic gastrointestinal,urinary,and hematologic toxicities (P＜ 0.05).Conclusions IGRT-VMAT can correct setup error online,shorten the treatment time,reduce the dose to organs at risk,and alleviate acute and chronic toxicities,and is especially suitable for patients with postoperative small bowel position changes.
ABSTRACT
Objective:To explore the factors affecting the postoperative prognosis of early cervical squamous cell carcinoma and inves-tigate the different radiotherapy techniques. Methods:A total of 100 postoperative patients of early cervical squamous cell carcinoma treated in Affiliated Tumor Hospital of Xinjiang Medical University and Affiliated Tumor Hospital of Sun Yat-sen University from March to September 2013 were enrolled in our study. The prognostic factors for these patients were analyzed. After being subjected to differ-ent postoperative radiotherapy techniques, the efficacy and complications of the techniques were assessed for patients, including 50 cases of conventional radiotherapy (CRT) and 50 cases of image-guided radiotherapy (IGRT). Results:The 3-year overall survival rate was 89%, and the 3-year disease-free survival rate was 78%. The 3-year overall survival rates of the CRT and IGRT groups were 78.57%and 89.06%, respectively. The difference between these rates was statistically significant (P=0.034). The 3-year survival rates of the CRT and IGRT groups were 66.67%and 87.36%, respectively. The difference was statistically significant (P=0.042). The incidence of ear-ly and late complications in the CRT group was higher than that in IGRT group, and the difference of P<0.05 was statistically significant. Multivariate analysis showed that postoperative radiotherapy, parametrial invasion, lymph node metastasis, lymphovascular space in-vasion, perineural invasion, and deep stromal invasion were the independent risk factors for the prognosis of patients with early stage cervical squamous cell carcinoma. Conclusion:Early prognosis of cervical squamous cell carcinoma results from the interaction of mul-tiple factors. The 3-year survival rate of the IGRT group was significantly better than that of the CRT group in the early stage of cervical squamous cell carcinoma. IGRT alleviates acute and chronic toxicities and helps improve the quality of life of patients.
ABSTRACT
Objective To investigate the efficacy and toxicity of concurrent chemoradiotherapy with nedaplatin versus cisplatin for patients with middle-advanced stage uterine cervical carcinoma.Methods 180 patients with middle-advanced stage uterine cervical carcinoma were randomized into concurrent chemoradiotherapy with nedaplatin group (nedaplatin group) and concurrent chemoradiotherapy with cisplatin group (cisplatin group).The short-term efficacy and the toxicity were observed.Results In the nedaplatin group,the short-term response rate、the one-year relapse-free surviva l、one-yea metastasis-free survival、the two-year relapse-free survival、the two-year metastasis-free survival were 98.85％、89.66、86.21％ 、85.06％ 和 80.46％,But in the cisplatin group,the short-term response rate 、the one-year relapse-free surviva l、one-yea metastasis-free survival、the twoyear relapse-free survival、the two-year metastasis-free survival were 97.60％ (x2 =3.07,P ＞ 0.05) 、81.93％(x2 =3.07,P ＞0.05) 、83.13％ (x2 =0.31,P ＞0.05) 、78.31％ (x2 =1.30,P ＞0.05) 和 80.72％ (x2 =0.00,P ＞ 0.05),so there was no significant difference.The incidences of nausea and vomiting in the cisplatin group were 52.27％ (grade Ⅰ ～ Ⅳ toxicities),12.50％ (grade Ⅲ ～ Ⅳ toxicities),which were higher than those in the nedaplatin group 27.27％ (grade Ⅱ ～ Ⅳ toxicities),6.82％ (grade Ⅲ ～ Ⅳ toxicities) (P ＜ 0.05),while there were no significant difference in the other toxicities such as anemia,granulocytopenia,thrombocytopenia,diarrhoea between the two groups (x2 =12.18,P ＞ 0.05).Conclusion The efficacy of concurrent chemoradiotherapy with nedaplatin is the same as that of concurrent chemoradiotherapy with cisplatin,and its toxicity is well-tolerated.
ABSTRACT
Objective To evaluate the efficacy of the intensity modulated radiotherapy in early stage cervical cancer with vaginal stump recurrence after surgery.Methods A retrospective concurrent comparative study included 60 patients with vaginal recurrence after surgery in early stage cervical cancer.30 cases of the experimental group were treated with intensity-modulated radiotherapy (IMRT),and 30 cases of the control group were treated with conventional radiotherapy.The efficacy and complications between two groups were compared after 3 treatment cycles.Results Of 30 patients in experimental group,22 patients achieved complete remission,7 had partial and 1 progressed.But in the control group,14 had complete remission,5 reached partial remission,7 were stable and 4 progressed.The effective rates were 96.67 ％ (29/30) and 63.33 ％ (19/30),respectively,in the experimental and control group,which showed statistical significance (P =0.009).In the experimental group,there were 1 case with grade 1 radiation cystitis and 1 case with grade 1 radiation proctitis.In the control group,there were 3 cases of vaginal-rectal fistula,1 case of grade 3 radiation proctitis,2 cases of grade 2 radiation cystitis and 2 cases of grade 1 radiation proctitis.Conclusions IMRT for treating vaginal recurrence of early cervical cancer achieves satisfactory short-term effect.In comparison with conventional radiotherapy,IMRT has higher efficacy but less side effects.
ABSTRACT
Objective: To explore the value of implanted intensity-modulated bmchytherapy for recurred cervical carcinoma. Metheds: A total of 25 cases of recurred cervical carcinoma were enrolled into the trial group which were treated with pelvic implanted aftedoading intensity-modulated brachytherapy. The other 25 patients with recurred cervical carcinoma treated with routine brachytherapy during the same pedod were en-rolled into the control group. Results: There were 20 cases with CR and 5 cases with PR in the trial group, and 10 cases with CR, 7 cases with PR, 4 cases with SD and 4 cases with PD in the control group, with a signifi-cant difference between the two groups (P<0.05). In the trial group, there were 5 cases with vaginal-rectal fis-tula and 1 case with grade 3 enteritis. In the control group, there were 3 cases with vaginal-rectal fistula. Con-dusion: Pelvic implanted intensity-modulated brachytherapy for recurred cervical carcinoma is satisfactory with better short-term efficacy than that of the routine brachytherapy and tolerable side effects.
ABSTRACT
Objective:To explore the relationship between the accelerated repopulation of tumor cells in the afterloading fractionated radiation therapy and the radiation dose,Ki67 antigen,PcNA & mutation p53 antigen expression were analyzed by continual biopsy on the same patients of cervical carcinoma two weeks (10 Gy)and four weeks(20 Gy).Methods:Ki67 antigen expression and cell cycle analysis (SPF,PI,DEN) were checked by flow cytometry,PCEA & mutation p53 antigen expression were checked by means of immunohistochemical technique and computerized image cytometry.All these indexes were viewed on their relationship with the irradiation dose.Rusults:Ki67 antigen expression and DEN were increased as radiation dose increased.The difference of Ki67,PCNA and mtP53 antigen expression at the dose of 10 Gy had statistical significance compared with before brachytherapy,but it had no statistical significance compared with at the dose of 20 Gy.Conclusion:It may be concluded that the tumor cell repopulation had occurred at the dose of 10 Gy (two weeks after brachytherapy).But these markers were not obviously changed compared with at the dose of 20 Gy,so it leads to a conclusion that tumor cell repopulation was stable.It also offers the theory basis to select the opportunity of accelerated brachytherapy of cervical carcinoma.