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1
題名:A DOSIMETRIC COMPARISON OF THE PREDICTIVE VALUE OF TWO RECTAL REFERENCE POINTS FOR LATE RECTAL COMPLICATIONS FOLLOWING THE TREATMENT OF CERVICAL CANCER BY HIGH-DOSE-RATE BRACHYTHERAPY     (22點)
直腸劑量參考點對子宮頸癌放射線治療引發之直腸後遺症的預測價值之比較
著者:Shang-Wen Chen(陳尚文) ;Ji-An Liang(梁基安) ;Shih-Neng Yang(楊世能) ;Hui-Ling Ko(柯卉玲) ;Cheng-Pang Tu(涂振邦) ;An-Cheng Shiau(蕭安成) ;Fang-Jen Lin(林芳仁)
出版地區:台灣
出版城市:台北市
學科:醫學綜合
關鍵字:子宮頸癌 ; 近接治療 ; 直腸後遺症 ; 放射劑量 ; Cervical cancer ; Brachytherapy ; Rectal sequelae ; Radiation dose
刊名:Therapeutic Radiology and Oncology
頁碼:41-51
語言:英語
摘要: 中文摘要PDF ; 英文摘要PDF

且且: 本研究主要在比較兩種宜腸劑量參考點對子宮頸癌放射線治療引發之宜腸出血後遺症的預測價值。 材料與肯注: 從1 9 9 2 年9 月至1 9 9 7 年1 2 月, 共有1 8 1 位在新光及中國醫藥學院附設醫院完成放射治療之子宮頸癌病人(第凹, IIA, lIB, IlIA, I1IB 期分別有泣, 刃, 1 0 2 ,3 , 21 人) 進入分析。所有病人皆存活一年以上,且長期存活者須經至少三年之追蹤檢查。放射治療範圓涵蓋整個子宮,陰道及下腹腔淋巴腺,經照射4 4 Gy 至4 5 Gy 後, 腫瘤期別超過lI B 的病人, 照野縮小至兩側的子宮旁組織( param etrium ) , 再給與1 4 Gy 0 高劑量率( H D R ) 子宮腔內近接治療間隔一週,其中5 1位病人治療次數3 次, 每次給予參考點A ( Point A ) 7,2 Gy 的劑量; 另13 0 位病人治療次數4 次, 每次給予參考點A (Po int A ) 6,0 Gy 的劑量, 每次近接治療時皆以1CRU 及傳統方式兩種方法來計算每位病人之宜腸劑量,總共之放射治療時間的至9 0 天(中位值6 0 天) 。由多變數分析來分析病人本身、近接治療及宜腸劑量等可能影響宜腸後遺症之因子,以找出發生後遺症之高危險群。 直直星: 1 81 位病患經過3 8 至110 個月的追蹤檢查( 中位值5 8 個月) , 45 人( 24 , 9 % ) 發生RTOG 第一至第四級之宜腸後遺症( 第一、第二、第三至四級分別有27 、1 3 及5 人) 。直腸後還症發生的機率與累積之I C RU直腸劑量參考點劑量有較明顯的相關性。多變數分析後發現第lIB - III 期( p = 0 ,00 2 ) 及累積之ICRU 宜腸劑量參考點劑量大於20 Gy ( p = 0.005 ) 為引發宜腸後遺症之高危險群。 益益: 研究結果確定I C R U 宜腸劑量參考點對預測直腸後遺症的價值, 而以傳統方式計算之宜腸劑量與直腸後遺症的發生並沒有很好的相關性。本研究建議,在不影響治療結果的前提下,針對宜腸後遺症之高危險群,應調整治療計劃,以減少後遺症發生的機率。
Purpose : This study aimed to compare the predictive value of ICRU (International Committee on Radiation Units and Measurements) and conventional rectal reference point with the risk of late rectal sequelae in patients with carcinoma of the uterine cervix treated with high-dose-rate intracavitary brachytherapy (HDRICB). Materials and Methods : From September 1992 to December 1997, 181 cases (32 IB, 23 IIA, 102 IIB, 3 IIIA, 21 IIIB) who survived more than 12 months after treatment and the long-term survivors should receive a minimum 3 years of follow-up, were entered in our study. Initially, they were treated with 10 MV X-rays for 44 - 45 Gy / 22 - 25 fractions over 4-5 weeks to whole pelvis. Radiation dose for patients with FIGO Stage IIB-III bilateral parametrial disease was boosted to 54-58 Gy, with a central shielding. After the completion of whole-pelvis radiotherapy, HDRICB was performed using an Ir-192 remote after-loading technique at one-week intervals. Fifty-one patients received three insertions, while 130 patients had four insertions. The prescribed dose for each HDRICB was 7.2 Gy to Point A for three insertions (before July 1995), or 6.0 Gy for four insertions (after July 1995). HDRICB dosimetry was calculated using orthogonal films exposed during each insertion. Doses to both ICRU and conventional rectal reference points were calculated for each patients. The overall duration of treatment ranged from 47-90 days (median, 60). Patient and treatment related factors were evaluated for late rectal complication using logistic regression model. Results : Median follow-up of these patients was 58 months (range: 38-110 months). Forty-five patients (24.9%) had late rectal complications (27 Grade 1, 13 Grade 2, 5 Grade 3-4). The probability of rectal complications shows a better correlation of doseresponse with increasing total brachytherapy ICRU rectal dose. Multivariate logistic regression analysis demonstrated a high risk of late rectal sequelae in patients who had Stage IIB-III disease (p = 0.002, relative risk, 3.66, 95% CI 1.82-6.45) and total ICRU rectal dose greater than 20 Gy (p = 0.005, relative risk, 1.62, 95% CI 1.03-3.21). Conclusions : This study confirms the value of ICRU rectal reference point in the prediction of late rectal sequelae. Patients who have Stage IIB-III disease, or a total ICRU rectal dose greater than 20 Gy, have a higher risk of late rectal sequelae.


    

本卷期目次
Therapeutic Radiology and Oncology
Rarely Reported Liver Toxicity in Patients Who Were Hepatitis B Carrier and Underwent Chemoirradiation for Gastric Cancer/ Chao-Ming HuangJason Chia-Hsien ChengStella Y. TsaiMei-Ching LiuYih-Lin ChungSkye Hon-Giun ChengWei-Tse FangPo-Sheng YangJames Jer-Min JianAndrew T. Huang
Post-Operative Combination of Radiotherapy and Chemotherapy in Esophageal Cancer/ Chien-Hsun ChenChing-Hsiung ChangYu-Chang HuChung-Man LeungKuo-Chen Chang
子宮頸癌術後放射線治療病人組織病理學預後因子之多變數分析/ 賴耿光馬玉麟許瑞昌葉坤土賴義雄林隆堯周明智
電腦斷層模擬攝影應用於全腦脊椎照射照野之設計與評估/ 曾雁明陳臣苑陳汶城林俊彥姚學華李紳豪曾振淦
A Dosimetric Comparison of the Predictive Value of Two Rectal Reference Points for Late Rectal Complications Following the Treatment of Cervical Cancer by High-Dose-Rate Brachytherapy/ Shang-Wen ChenJi-An LiangShih-Neng YangHui-Ling KoCheng-Pang TuAn-Cheng ShiauFang-Jen Lin
胸部固定器設計與臨床上之應用/ 呂宗憲蕭世禎吳錦榕阮昭銘朱慶文葉如娦彭秋萍游佩潔
Analysis on the Variation of Respiratory organ motion and a Preliminary Feasibility Study for a Voice Coaching Technique to Improve the Reproducibility of Respiratory Cycle between Tteatiments/ James C. LiWen-Shan LiuHsiang-Chi KuoLi-Miao ChenDavid HuangChi-Wei HsuHis-Chang Chang
ANALYSIS ON THE VARIATION OF RESPIRATORY ORGAN MOTION AND A PRELIMINARY FEASIBILITY STUDY FOR A VOICE COACHING TECHNIQUE TO IMPROVE THE REPRODUCIBILITY OF RESPIRATORY CYCLE BETWEEN TREATMENTS/ James C. LiWen-Shan LiuHsiang-Chi KuoLi-Miao ChenDavid HuangChi-Wei HsuHis-Chang Chang
POST-OPERATIVE COMBINATION OF RADIOTHERAPY AND CHEMOTHERAPY IN ESOPHAGEAL CANCER/ Chien-Hsun ChenChing-Hsiung ChangYu-Chang HuChung-Man LeungKuo-Chen Chang
電腦斷層模擬攝影應用於全腦脊椎照射照野之設計與評估/ 曾雁明陳臣苑陳汶城林俊彥姚學華李紳豪曾振淦
RARELY REPORTED LIVER TOXICITY IN PATIENTS WHO WERE HEPATITIS B CARRIER AND UNDERWENT CHEMOIRRADIATION FOR GASTRIC CANCER/ Chao-Ming HuangJason Chia-Hsien ChengStella Y. TsaiMei-Ching LiuYih-Lin ChungSkye Hon-Giun ChengWei-Tse FangPo-Sheng YangJames Jer-Min JianAndrew T. Huang
A DOSIMETRIC COMPARISON OF THE PREDICTIVE VALUE OF TWO RECTAL REFERENCE POINTS FOR LATE RECTAL COMPLICATIONS FOLLOWING THE TREATMENT OF CERVICAL CANCER BY HIGH-DOSE-RATE BRACHYTHERAPY/ Shang-Wen ChenJi-An LiangShih-Neng YangHui-Ling KoCheng-Pang TuAn-Cheng ShiauFang-Jen Lin
子宮頸癌術後放射線治療病人組織病理學預後因子之多變數分析/ 賴耿光馬玉麟許瑞昌葉坤土賴義雄林隆堯周明智
胸部固定器設計與臨床上之應用/ 呂宗憲蕭世禎吳錦榕阮昭銘朱慶文葉如?彭秋萍游佩潔
 
   
 
   

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