Objective To explore the possibility and biological effect in clinic by applying unconventional fractionation of intracavitary brachytherapy. Methods In vitro radiotherapy + high dose rate brachytherapy (HDR) cavity radiotherapy were applied in the treatment: the accelerator 6 MV-X lines by Simens were used in vitro illumination; around entire pelvic cavity 2 wilds central technology illuminations etc were also used; integral dose was 46-50 Gy, 23-25 fractions, for 5 weeks. When external irradiation entire pelvic cavity dosage was 30 Gy, 15 fractions the pelvic cavity central kept off the lead (4 cm×10 cm) and started to work in short-distance cavity treatment. The 192Ir high dose rate breech loading therapeutic equipment was used, without cavity internal radiation in vitro illumination at the same day. In the HDR cavity the ultra divisiongroup: point A (Ⅱb, Ⅲ) received 4 Gy perfraction, twice daily of intracavitary irradiation at point A. The intrafraction interval was more than 6 hours daily. The total dose at point A was 40 Gy in 10 fractions, 5 days, 3-4 weeks. In HDR cavity conventional division group: point A (ⅡI b, Ⅲ) received 6 Gy perfraction. The total dose at point A was 36 Gy in 6 fractions, 6 days, 6 weeks. Results By the end of radiotherapy, local control of 24 patients complete remission + partial remission was 100% and the control was 95.83% after a year. Early vagina reaction was: I degree for 10 cases, Ⅱ degree for 11 cases and Ⅲ degree for 3 cases. The reaction did not cause any break-up of treatment. Conclusion Enough fractionation including fraction number and dose perfraction are very important to improve the treatment effect and decrease the later complications of the HDR intracavitary brachytherapy for cervix carcinoma. The method is applicable because of its satisfactory early effects. Further follow-up is needed to evaluate its survival rate as well as later tissue injury.%目的 采用非常规的腔内治疗分割方式,探讨方法的可行性与临床生物剂量效应.方法 体外放疗+高剂量率近距离腔内放疗:体外照射采用西门子加速器6MVX射线,全盆腔前后2野等中心技术照射,总剂量46～50 Gy,23～25次,5周,外照射全盆腔剂量30 Gy,15次时盆腔中央挡铅(4 cm× 10 cm),并开始配合腔内近距离治疗,采用192Ir高剂量率后装治疗机,腔内照射当天不做体外照射.腔内放疗超分割组:Ⅱb、Ⅲ期A点4 Gy/次,2次/d,两次间隔≥6h,每5d重复治疗1次,总计10次,3～4周,A点剂量40 Gy;腔内放疗常规分割组:Ⅱb、Ⅲ期A点6 Gy/次,1次/d,每周重复治疗1次,总计6次,6周,A点剂量36 Gy.结果 24例患者治疗结束时肿瘤局部疗效完全缓解+部分缓解为100％,1年局部控制率为95.83％.阴道反应Ⅰ度10例,Ⅱ度11例,Ⅲ度3例,无1例因反应而导致治疗非计划中断.结论 体外放疗+高剂量率近距离腔内放疗方法可行,近期疗效满意,其治疗宫颈癌提高疗效、减少晚期并发症的关键是应用足够的分割(包括次数及剂量),但晚反应组织损伤、远期生存率尚待进一步随访及评诂.
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