Recent Therapeutic Observation Of Brachytherapy Implantation In Local Intermediate And Advanced Cervical Cancer

Aims:Discuss the recent curative effect of brachytherapy implantation in local intermediate and advanced cervical cancer.Methods and materials:Select 106 cases of Local Intermediate and Advanced Cervical Cancer,aged 41 to 67 years old(the average age is 51.45 years),from December 2013 to January 2016 in the department of radiotherapy of our hospital. All the patients selected into the group are diagnosed clearly with pathologic results and clinical stage.According to NCCN clinical practice guidelines of cervical cancer in 2015, the selected cases includeⅡstage A2 3 cases, Ⅱstage B 33 cases, Ⅲ stage A 31 cases, Ⅲ stage B 30 cases, Ⅳ A stage 9 cases.The treatment plan includes Intensity Modulated Radiation Therapy(IMRT) and High-Dose Rate Intracavitary Brachytherapy(HDR-ICBT),with synchronous chemotherapy to increased the sensitization of radiation therapy.The same treatment plan is given to the selected patients.They are all treated with external exposure50.4Gy/28 fractions, and chemotherapy 1 time per week to increased the sensitization of radiation therapy,totally for 6 to 7 weeks. If the lymph node(s)of abdominal aorta or pelvic cavity is(are) positive, 8-10 Gy is added.After the external exposure,the patients who would undergo High-Dose Rate Intracavitary Brachytherapy are divided into two groups.For one group,53 patients would be treated with CT guiding three-dimensional High-Dose Rate Intracavitary Brachytherapy, dose36Gy/6 fractions,which is called control group.For the other group,53 patients would be treated with CT guiding three-dimensional High-Dose Rate Intracavitary Brachytherapy combined with para-cervix implantation,under the same dose,which is called experimental group.Method is that cavity tube source applicator placed is based on the uterine depth of patients. According to the size of the tumor and infringement, surgeon carry out unarmed planting.According to physical examination and imaging data,surgeon determine the location of the pinhole and the number of inserted needle graft(usually 5-7needles).Through real-time images of CT guided into the needle Angle correction, and to determine the depth of each needle optimal inserted embedded, general for 3-5 cm. Brachytherapy implantation 2 time per week. Observe and record the tumor regression, timely deal with adverse reactions. After radiotherapy, continue to consolidate the TP chemotherapy, 1 time per 4 weeks, chemotherapy cycle is 6 weeks. After completion of treatment, patients would be periodic review to our department and telephone follow-up on a regular basis. This research mainly observed recent curative effect, and the incidence of complications,such as cystitis, rectitis.Results:Among 53 cases after Intracavitary Brachytherapy, four patients(11%) have relapse in the cervix and/or near the palace area, two patients appear distant metastases,recent effective rate of 1 year is 85%.21patients(39.6%) suffer radioactive dermatitis complications.16patients(30,2%) suffer level 1-3 early and late radiation proctopathy complications.14 patients(26.4%) suffer level 1-3 early and late radiocystitis.Among 53 cases after brachytherapy implantation, one patient(2%) have relapse in the cervix and/or near the palace area, one patient appear distant metastases,recent effective rate of 1 year is 96%.19patients(35.8%) suffer radioactive dermatitis complications.7patients(13,2%) suffer level 1-3 early and late radiation proctopathy complications.5 patients(9.4%) suffer level 1-3 early and late radiocystitis.The curative effect is different between two groups,with statistical significance(P<0.05).There are different in incidence,such as cystitis, rectitis, with statistical significance(P<0.05).The incidence of radioactive dermatitis is not different between two groups, without statistical significance(P>0.05).Conclusion:The recent curative effect of Brachytherapy implantation is better than Intracavitary Brachytherapy in local intermediate and advanced cervical cancer.The incidence of radiation proctopathy and cystitis is lower than that of Intracavitary Brachytherapy.We prefer Brachytherapy implantation,because it is more safe and effective.