宫颈癌近距离放疗的研究进展

doi:10.12280/gjfckx.20210574

摘要/Abstract

摘要：

宫颈癌是我国女性生殖道最常见的恶性肿瘤,严重威胁女性健康。近距离放射治疗可提高肿瘤局部放射剂量,同时减少对正常组织的损伤,是局部晚期宫颈癌治疗中不可或缺的重要组成部分。近年来,三维后装近距离放疗、组织间插植近距离放疗和放射性粒子植入近距离放疗等技术迅猛发展,进一步提高了宫颈癌的治疗效果。三者互为联系,对于偏心肿瘤,腔内后装放射治疗靶区覆盖不全、剂量分布适形度不佳,而组织间插植放射治疗可弥补腔内后装放射治疗的不足。放射性粒子植入放疗具有创伤小、安全性高等特点,为复发性宫颈癌患者提供更多的可能。因此,在临床中应根据患者病情特点,为其制定个体化治疗方案。

关键词: 宫颈肿瘤, 近距离放射疗法, 碘放射性同位素, 放射性, 3D打印, 体层摄影术

Abstract:

Cervical cancer is the most common malignant tumor of female reproductive tract in China, which seriously threatens women′s health. Brachytherapy is an essential component of the treatment of locally advanced cervical cancers. It enables the dose to the tumor to be boosted whilst allowing relative sparing of the normal tissues. In recent years, three-dimensional brachytherapy, interstitial implantation brachytherapy and radioactive seed implantation brachytherapy have developed rapidly. These technologies have improved the treatment effect of cervical cancer and reduced complications. The three factors are interrelated. For eccentric tumor, intracavitary brachytherapy has incomplete target coverage and poor dose distribution conformation, while interstitial implantation brachytherapy can make up for the deficiency of intracavitary brachytherapy. Radioactive seed implantation brachytherapy has the characteristics of low trauma and high safety, providing more possibilities for patients with recurrent cervical cancer. Therefore, individualized treatment plan should be formulated according to the characteristics of the patient′s condition in clinical practice.

Key words: Uterine cervical neoplasms, Brachytherapy, Iodine radioisotopes, Radioactivity, 3D printing, Tomography

金鸽, 李魁秀, 郭云峰, 高阳阳. 宫颈癌近距离放疗的研究进展[J]. 国际妇产科学杂志, 2022, 49(2): 202-206.

JIN Ge, LI Kui-xiu, GUO Yun-feng, GAO Yang-yang. Research Progress in Brachytherapy for Cervical Cancer[J]. Journal of International Obstetrics and Gynecology, 2022, 49(2): 202-206.

参考文献 28

[1]	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6):394-424. doi: 10.3322/caac.21492. doi: 10.3322/caac.21492
[2]	Small W Jr, Bacon MA, Bajaj A, et al. Cervical cancer: A global health crisis[J]. Cancer, 2017, 123(13):2404-2412. doi: 10.1002/cncr.30667. doi: 10.1002/cncr.30667
[3]	Ginsburg O, Bray F, Coleman MP, et al. The global burden of women′s cancers: a grand challenge in global health[J]. Lancet, 2017, 389(10071):847-860. doi: 10.1016/S0140-6736(16)31392-7. doi: S0140-6736(16)31392-7 pmid: 27814965
[4]	Mayadev J, Viswanathan A, Liu Y, et al. American Brachytherapy Task Group Report: A pooled analysis of clinical outcomes for high-dose-rate brachytherapy for cervical cancer[J]. Brachytherapy, 2017, 16(1):22-43. doi: 10.1016/j.brachy.2016.03.008. doi: S1538-4721(16)30015-0 pmid: 28109631
[5]	Sturdza A, Pötter R, Fokdal LU, et al. Image guided brachytherapy in locally advanced cervical cancer: Improved pelvic control and survival in RetroEMBRACE, a multicenter cohort study[J]. Radiother Oncol, 2016, 120(3):428-433. doi: 10.1016/j.radonc.2016.03.011. doi: S0167-8140(16)31018-0 pmid: 27134181
[6]	丁文婷, 邢舒, 何丽, 等. 三维近距离放射治疗Ⅱb-Ⅳa期宫颈癌效果及预后观察[J]. 临床误诊误治, 2021, 34(1):92-97. doi: 10.3969/j.issn.1002-3429.2021.01.020. doi: 10.3969/j.issn.1002-3429.2021.01.020
[7]	Derks K, Steenhuijsen J, van den Berg HA, et al. Impact of brachytherapy technique (2D versus 3D) on outcome following radiotherapy of cervical cancer[J]. J Contemp Brachytherapy, 2018, 10(1):17-25. doi: 10.5114/jcb.2018.73955. doi: 10.5114/jcb.2018.73955
[8]	Pötter R, Tanderup K, Schmid MP, et al. MRI-guided adaptive brachytherapy in locally advanced cervical cancer (EMBRACE-I): a multicentre prospective cohort study[J]. Lancet Oncol, 2021, 22(4):538-547. doi: 10.1016/S1470-2045(20)30753-1. doi: 10.1016/S1470-2045(20)30753-1
[9]	Haie-Meder C, Pötter R, Van Limbergen E, et al. Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group (I): concepts and terms in 3D image based 3D treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV[J]. Radiother Oncol, 2005, 74(3):235-245. doi: 10.1016/j.radonc.2004.12.015. doi: 10.1016/j.radonc.2004.12.015 pmid: 15763303
[10]	Schmid MP, Kirisits C, Nesvacil N, et al. Local recurrences in cervical cancer patients in the setting of image-guided brachytherapy: a comparison of spatial dose distribution within a matched-pair analysis[J]. Radiother Oncol, 2011, 100(3):468-472. doi: 10.1016/j.radonc.2011.08.014. doi: 10.1016/j.radonc.2011.08.014
[11]	Dimopoulos JC, Lang S, Kirisits C, et al. Dose-volume histogram parameters and local tumor control in magnetic resonance image-guided cervical cancer brachytherapy[J]. Int J Radiat Oncol Biol Phys, 2009, 75(1):56-63. doi: 10.1016/j.ijrobp.2008.10.033. doi: 10.1016/j.ijrobp.2008.10.033
[12]	Mazeron R, Castelnau-Marchand P, Escande A, et al. Tumor dose-volume response in image-guided adaptive brachytherapy for cervical cancer: A meta-regression analysis[J]. Brachytherapy, 2016, 15(5):537-542. doi: 10.1016/j.brachy.2016.05.009. doi: 10.1016/j.brachy.2016.05.009 pmid: 27371991
[13]	Fokdal L, Pötter R, Kirchheiner K, et al. Physician assessed and patient reported urinary morbidity after radio-chemotherapy and image guided adaptive brachytherapy for locally advanced cervical cancer[J]. Radiother Oncol, 2018, 127(3):423-430. doi: 10.1016/j.radonc.2018.05.002. doi: S0167-8140(18)30242-1 pmid: 29784450
[14]	Tanderup K, Lindegaard JC, Kirisits C, et al. Image Guided Adaptive Brachytherapy in cervix cancer: A new paradigm changing clinical practice and outcome[J]. Radiother Oncol, 2016, 120(3):365-369. doi: 10.1016/j.radonc.2016.08.007. doi: S0167-8140(16)31248-8 pmid: 27555228
[15]	Tharavichitkul E, Chakrabandhu S, Klunklin P, et al. Intermediate-term results of trans-abdominal ultrasound (TAUS)-guided brachytherapy in cervical cancer[J]. Gynecol Oncol, 2018, 148(3):468-473. doi: 10.1016/j.ygyno.2018.01.015. doi: S0090-8258(18)30047-7 pmid: 29398070
[16]	Théodore C, Levaillant JM, Capmas P, et al. MRI and Ultrasound Fusion Imaging for Cervical Cancer[J]. Anticancer Res, 2017, 37(9):5079-5085. doi: 10.21873/anticanres.11925. doi: 10.21873/anticanres.11925 pmid: 28870937
[17]	Lin X, Wang JP, Liu ZS, et al. Dose distribution of brachytherapy for locally advanced (stage IIB) cervical cancer[J]. Brachytherapy, 2020, 19(1):66-72. doi: 10.1016/j.brachy.2019.10.004. doi: 10.1016/j.brachy.2019.10.004
[18]	Nag S, Erickson B, Thomadsen B, et al. The American Brachytherapy Society recommendations for high-dose-rate brachytherapy for carcinoma of the cervix[J]. Int J Radiat Oncol Biol Phys, 2000, 48(1):201-211. doi: 10.1016/s0360-3016(00)00497-1. doi: 10.1016/s0360-3016(00)00497-1
[19]	Murakami N, Kobayashi K, Kato T, et al. The role of interstitial brachytherapy in the management of primary radiation therapy for uterine cervical cancer[J]. J Contemp Brachytherapy, 2016, 8(5):391-398. doi: 10.5114/jcb.2016.62938. doi: 10.5114/jcb.2016.62938
[20]	Murakami N, Kato T, Miyamoto Y, et al. Salvage High-dose-rate Interstitial Brachytherapy for Pelvic Recurrent Cervical Carcinoma After Hysterectomy[J]. Anticancer Res, 2016, 36(5):2413-2421. pmid: 27127151
[21]	张永侠, 袁香坤, 苗珺珺, 等. 3D打印模板应用于局部晚期宫颈癌后装放疗的剂量学研究[J]. 中华放射医学与防护杂志, 2020, 40(7):519-523. doi: 10.3760/cma.j.issn.0254-5098.2020.07.005. doi: 10.3760/cma.j.issn.0254-5098.2020.07.005
[22]	Liu ZS, Guo J, Zhao YZ, et al. Salvage interstitial brachytherapy based on computed tomography for recurrent cervical cancer after radical hysterectomy and adjuvant radiation therapy: case presentations and introduction of the technique[J]. J Contemp Brachytherapy, 2016, 8(5):415-421. doi: 10.5114/jcb.2016.63192. doi: 10.5114/jcb.2016.63192
[23]	郭小青, 廖晓红, 何静, 等. 三维后装插植放疗治疗阴道残端复发肿瘤[J]. 江西医药, 2019, 54(6):583-585,592. doi: 10.3969/j.issn.1006-2238.2019.6.001. doi: 10.3969/j.issn.1006-2238.2019.6.001
[24]	王琢, 陈健, 王宏雨, 等. 组织间插植近距离治疗和腔内近距离治疗对局部晚期宫颈癌患者生存期和生存质量的影响[J]. 中国医学前沿杂志(电子版), 2019, 11(10):90-94. doi: 10.12037/YXQY.2019.10-20. doi: 10.12037/YXQY.2019.10-20
[25]	Han L, Li C, Wang J, et al. Iodine-125 radioactive seed tissue implantation as a remedy treatment for recurrent cervical cancer[J]. J Cancer Res Ther, 2016,12(Suppl):C176-C180. doi: 10.4103/0973-1482.200611. doi: 10.4103/0973-1482.200611
[26]	Qu A, Jiang P, Sun H, et al. Efficacy and dosimetry analysis of image-guided radioactive ¹²⁵I seed implantation as salvage treatment for pelvic recurrent cervical cancer after external beam radiotherapy[J]. J Gynecol Oncol, 2019, 30(1):e9. doi: 10.3802/jgo.2019.30.e9. doi: 10.3802/jgo.2019.30.e9
[27]	江萍, 郭福新, 姜玉良, 等. 3D打印非共面模板辅助CT引导¹²⁵I粒子植入治疗盆腔复发子宫颈癌的剂量学研究[J]. 中华放射医学与防护杂志, 2017, 37(7):490-494. doi: 10.3760/cma.j.issn.0254-5098.2017.07.003. doi: 10.3760/cma.j.issn.0254-5098.2017.07.003
[28]	Liu Y, Jiang P, Zhang H, et al. Safety and efficacy of 3D-printed templates assisted CT-guided radioactive iodine-125 seed implantation for the treatment of recurrent cervical carcinoma after external beam radiotherapy[J]. J Gynecol Oncol, 2021, 32(2):e15. doi: 10.3802/jgo.2021.32.e15. doi: 10.3802/jgo.2021.32.e15