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首页> 外文期刊>Radiotherapy and oncology: Journal of the European Society for Therapeutic Radiology and Oncology >Compensation for changes in dose-rate in radical low-dose-rate brachytherapy: a radiobiological analysis of a randomised clinical trial.
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Compensation for changes in dose-rate in radical low-dose-rate brachytherapy: a radiobiological analysis of a randomised clinical trial.

机译：根治性低剂量率近距离放射治疗中剂量率变化的补偿：一项随机临床试验的放射生物学分析。

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BACKGROUND AND PURPOSE: This study reanalysed the results of the Cs-137 low-dose-rate brachytherapy trials for stage I and II cervix carcinoma at the Christie Hospital, Manchester, UK, in order to quantify the clinical outcome as a function of dose, and to extract radiobiological parameter values by modelling the data for local control and morbidity. PATIENTS AND METHODS: Kaplan-Meier survival curves and Cox regression analyses were used to analyse the time to event data. Linear-quadratic (LQ) analysis was also used in a mixture model, incorporating a half-time for repair, a time factor, and a heterogeneity function between patients. Full 5-year follow-up data were available for 339 patients receiving Cs-137 doses between 60 and 75 Gy delivered at 1.4-1.8 Gy/h, and 178 patients receiving a Ra-226 dose of 75 Gy at 0.5 Gy/h, using two insertions 7-10 days apart. RESULTS: With the increased dose-rate, a dose reduction between 20 and 25% was required to achieve a similar morbidity rate. This reduction had a detrimental effect on tumour control, by about 15% points. Unexpectedly, this loss in local control did not lead to a decrease in cancer-specific survival. For both tumour control and complications a high [Formula: see text] and short half-time for repair best fitted the data, suggesting that consequential late reactions may be responsible for much of the bowel and urinary morbidity after these short treatments. The variability in response between patients was greater (CV 40%) for morbidity than for tumour control (CV 17%), probably reflecting the greater variation in dose at the target tissue. There was no significant dependence on overall treatment time detected over the 7-10-day range of these treatments. CONCLUSIONS: The therapeutic ratio was somewhat less for the higher dose-rate, in agreement with radiobiological expectations, although cancer-specific survival was inexplicably unchanged. The LQ-parameter analysis suggests that high [Formula: see text] ratios and/or short repair half-times are applicable for both tumour and normal tissue responses in these treatments.
机译：背景与目的：本研究重新分析了英国曼彻斯特克里斯蒂医院进行的Is和II期子宫颈癌Cs-137低剂量率近距离放射治疗试验的结果，以便量化随剂量变化的临床结局，并通过对数据进行建模以提取局部位置和发病率来提取放射生物学参数值。患者和方法：使用Kaplan-Meier生存曲线和Cox回归分析来分析事件数据的时间。混合模型还使用了线性二次（LQ）分析，其中包括了修复时间的一半，时间因素以及患者之间的异质性功能。有339位接受1.4至1.8 Gy / h的60至75 Gy Cs-137剂量的患者和178位接受0.5 Gy / h的75 Gy Ra-226剂量的178位患者的完整5年随访数据，相隔7-10天使用两次插入。结果：随着剂量率的增加，需要减少20％至25％的剂量才能达到相似的发病率。这种减少对肿瘤控制有不利影响，降低了约15％。出乎意料的是，这种局部控制的丧失并未导致癌症特异性存活率的降低。对于肿瘤控制和并发症而言，较高的[公式：参见文本]和较短的修复半衰期最适合该数据，这表明在这些短期治疗后，随之而来的晚期反应可能是导致肠道和尿毒症的主要原因。患者之间反应的变异性（CV 40％）大于肿瘤对照（CV 17％），这可能反映了目标组织剂量的较大变化。在这些治疗的7-10天范围内，检测到的总治疗时间没有显着依赖性。结论：较高剂量率的治疗率略低，与放射生物学的期望相符，尽管癌症特异性存活率无法解释地保持不变。 LQ参数分析表明，高比率和/或短修复时间适用于这些治疗中的肿瘤和正常组织反应。

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