| Aims:To retrospective analysis of the efficacy and toxicity of patients with locally advanced cervical cancer treated with brachytherapy Implantation.Methods and materials:A total of 279 patients with locally advanced cervical cancer admitted to the department of radiotherapy,Second Hospital of Jilin University from March 2015 to October 2017,aged 23-80 years,with an average age of 56.4 years,were selected.All patients were confirmed by pathological biopsy.According to the 2009 standard of FIGO staging of cervical cancer,279 patients were followed up for 1 year,48 patients were in IIA,124 in IIB,25 in IIIA,71 in IIIB,and 11 in IVA.136 patients were followed up for 2 years.There were 18 cases in stage IIA,64 cases in stage IIB,12 cases in stage IIIA,39 cases in stage IIIB,and 3 cases in stage IVA.There were 51 patients with 3 years of follow-up,5 cases in stage IIA,28 cases in stage IIB,and 4 cases in stage IIIA.Stage IIIB 14 cases.All patients were treated with external irradiation + synchronous sensitization chemotherapy + interstitial implantation radiotherapy.The external dose of prescription PTV was given a single 1.8Gy,once a day,5 times a week,the total dose was 50.4Gy,the lymph node positive patients with imaging or pathology confirmed,the positive lymph node area should be added to 60 Gy to 66 Gy.Simultaneous sensitization chemotherapy When all patients start external irradiation,cisplatin-based sensitizing chemotherapy is given to improve the radiotherapy effect.A dose of 30-40 mg/m2 is administered according to the surface area of the patient,and is matched with an auxiliary medication for relieving the chemotherapy response.During the interstitial implantation of radiotherapy,the patient took the lithotomy position,and after the vulva and vagina were fully disinfected,the vaginal device was used to dilate the vagina and implant the uterine cavity tube.Then insert 4 implant needles into the cervix parallel to the vagina about 1~2cm,distributed in the 4th corner of the cervix.After each pin,the vagina is filled with gauze soaked in saline to increase the distance between the implant needle and the bladder and rectum.It has the effect of fixing the implant needle.Under the guidance of CT,the angle and depth of the insertion needle are repeatedly adjusted to be evenly distributed in the lesion.According to GYN GEC-ESTRO’s recommendations,three target areas should be mapped,namely the tumor residual lesion target area(GTV),the high-risk clinical target area(HR CTV)and the intermediate risk clinical target area(IR CTV).The single prescription dose for interplantation radiotherapy is 6-7 Gy,the total dose is 30-36 Gy,and 1 or 2 treatments per week.A professional physicist then applies a reverse-planning treatment system to adjust the position and residence time of the radioactive source in the uterine lumen and metal insertion needle to achieve a perfect three-dimensional dose distribution.Finally,the technician connects the device to complete the treatment.Results:Among the 279 patients who were followed up for 1 year,the remission rate was 84.6%,the clinical benefit rate was 87.8%,the local control rate was 93.5%,the overall survival rate was 93.2%,and the progression-free survival rate was 87.7%.Among the 136 patients who were followed up for 2 years,the remission rate was 74.2%,the clinical benefit rate was 80.9%,the local control rate was 90.4%,the overall survival rate was 88.9%,and the progression-free survival rate was 80.7%.Among the 51 patients who were followed up for 3 years,the remission rate was 74.5%,the clinical benefit rate was 80.4%,the local control rate was 90.2%,the overall survival rate was 84.3%,and the progression-free survival rate was 80%.Radiotherapy toxicity: 21 patients(7.5%)with grade 3 or higher acute radiation proctitis,15 patients with chronic radiation proctitis(5.4),3 patients with acute radiation cystitis(1.1%),and 2 patients with chronic radiation cystitis(0.7).Most patients gave symptomatic relief after symptomatic treatment.Only one patient developed vaginal-rectal fistula and two patients developed severe bladder fibrosis.Conclusion:The effect of interplantation radiotherapy in the treatment of locally advanced cervical cancer is very significant.While improving the efficacy,it reduces the toxicity of radiotherapy,prolongs the survival of cervical cancer patients,and improves the quality of life.Inter-tissue implant radiotherapy is a safe and effective treatment and worth promoting. |
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