Salama Joseph K, Mundt Arno J, Roeske John, Mehta Neil
Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL 60637-1407, USA.
Int J Radiat Oncol Biol Phys. 2006 Jul 15;65(4):1170-6. doi: 10.1016/j.ijrobp.2006.02.041. Epub 2006 May 26.
The aim of this article is to report a preliminary analysis of our initial clinical experience with extended-field intensity-modulated radiotherapy for gynecologic malignancies.
Between November 2002 and May 2005, 13 women with gynecologic malignancies were treated with extended-field radiation therapy. Of the women, 7 had endometrial cancer, 4 cervical cancer, 1 recurrent endometrial cancer, and 1 suspected cervical cancer. All women underwent computed tomography planning, with the upper vagina, parametria, and uterus (if present) contoured within the CTV. In addition, the clinical target volume contained the pelvic and presacral lymph nodes as well as the para-aortic lymph nodes. All acute toxicity was scored according to the Common Terminology Criteria for Adverse Events (CTCAE v 3.0). All late toxicity was scored using the Radiation Therapy Oncology Group late toxicity score.
The median follow-up was 11 months. Extended-field intensity-modulated radiation therapy (IMRT) for gynecologic malignancies was well tolerated. Two patients experienced Grade 3 or higher toxicity. Both patients were treated with concurrent cisplatin based chemotherapy. Neither patient was planned with bone marrow sparing. Eleven patients had no evidence of late toxicity. One patient with multiple previous surgeries experienced a bowel obstruction. One patient with bilateral grossly involved and unresectable common iliac nodes experienced bilateral lymphedema. Extended-field-IMRT achieved good local control with only 1 patient, who was metastatic at presentation, and 1 patient not able to complete treatment, experiencing in-field failure.
Extended-field IMRT is safe and effective with a low incidence of acute toxicity. Longer follow-up is needed to assess chronic toxicity, although early results are promising.
本文旨在报告我们对妇科恶性肿瘤进行扩大野调强放射治疗的初步临床经验分析。
2002年11月至2005年5月期间，13例妇科恶性肿瘤患者接受了扩大野放射治疗。其中7例为子宫内膜癌，4例为宫颈癌，1例为复发性子宫内膜癌，1例为疑似宫颈癌。所有患者均接受了计算机断层扫描计划，CTV范围内勾勒出上阴道、宫旁组织和子宫（如有）。此外，临床靶区包括盆腔和骶前淋巴结以及腹主动脉旁淋巴结。所有急性毒性均根据不良事件通用术语标准（CTCAE v 3.0）进行评分。所有晚期毒性均采用放射肿瘤学组晚期毒性评分。
中位随访时间为11个月。妇科恶性肿瘤的扩大野调强放射治疗（IMRT）耐受性良好。2例患者出现3级或更高毒性。这2例患者均接受了基于顺铂的同步化疗。2例患者均未采用骨髓保护计划。11例患者无晚期毒性证据。1例曾多次接受手术的患者发生肠梗阻。1例双侧髂总淋巴结广泛受累且无法切除的患者出现双侧淋巴水肿。扩大野IMRT实现了良好的局部控制，仅1例初诊时已有转移的患者和1例无法完成治疗的患者出现野内失败。
扩大野IMRT安全有效，急性毒性发生率低。尽管早期结果令人鼓舞，但仍需要更长时间的随访来评估慢性毒性。
