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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.
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Objective:To standardize the naming of organ at risk (OAR) and target area during cervical cancer radiotherapy based on AAPM TG-263.Methods:After self-programming of Matlab software to implement the reading and resolution of radiotherapy structure files, the naming of each substructure was automatically output, recorded and restored. After naming all substructures, the structure names were classified by keywords. According to TG-263, a standard naming conversion table of OAR and target area was developed, and the classified structure names were standardized through procedures. Finally, the standardized named radiotherapy structure files were output and imported into the treatment planning system (TPS).Results:The radiation structure of 144 patients with cervical cancer was successfully transformed and displayed correctly in TPS. Before the transformation, the naming of OAR and target area lacked of uniform norms and standards, and the naming of the same structure significantly differed. After the transformation, 43 naming methods of OAR and 74 naming methods of the target area were unified into 20 and 8 naming methods, which were more convenient for staff understanding and communication.Conclusion:The standardization of cervical cancer radiotherapy structure naming can reduce the inconsistency of naming and provide reference for the standardized naming of pelvic tumors.
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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.
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Cervical cancer is one of the leading causes of death in women with malignancies worldwide.Brachytherapy plays an essential role in the radiation therapy for cervical cancer, and its combination with external beam radiation is indicated for previously untreated or recurrent cervical cancer at various stages without distant metastasis.Magnetic resonance imaging (MRI) has superior resolution of soft tissue, which allows for accurate delineation of target volume, protects organs at risk (OARs), and thus improves treatment outcomes.In recent years, many studies have demonstrated the feasibility and superiority of three-dimensional MRI-guided brachytherapy for cervical cancer.This article aims to elaborate on relevant MRI techniques, selection of applicators, delineation of target volume and OARs, evaluation of treatment plans, and the clinical effect of three-dimensional MRI-guided brachytherapy.
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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.
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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.