Chargari Cyrus, Magné Nicolas, Dumas Isabelle, Messai Taha, Vicenzi Lisa, Gillion Norman, Morice Philippe, Haie-Meder Christine
Department of Radiotherapy, Brachytherapy Service, Institut Gustave Roussy, Villejuif, France.
Int J Radiat Oncol Biol Phys. 2009 May 1;74(1):133-9. doi: 10.1016/j.ijrobp.2008.06.1912. Epub 2008 Sep 5.
To assess the physics contributions and clinical outcome with three-dimensional magnetic resonance imaging-guided pulsed-dose-rate (PDR) intracavitary brachytherapy in cervical cancer patients.
The data from 45 patients with primary locally advanced cervical carcinoma were analyzed. The median tumor cervical volume was 64.0 cm(3) (range, 3-178). Of the 45 patients, 24 (53%) had histologic and/or radiologic pelvic involvement. After pelvic with or without para-aortic concomitant chemoradiotherapy, a PDR brachytherapy boost was delivered to a three-dimensional magnetic resonance imaging-based clinical target volume, taking into account the dose-volume constraints for critical organs and optimization of the target volume coverage.
At a median follow-up of 26 months (range, 9-47), the 2-year overall survival and disease-free survival rate was 78% and 73%, respectively. At the last follow-up visit, the disease of all patients remained locally controlled. Adding external beam radiotherapy and PDR using the equivalent dose in 2-Gy fractions model, the median dose received by 100% and 90% of the target was 54.4 Gy(alpha/beta10) and 63.5 Gy(alpha/beta10) for the intermediate-risk clinical target volume and 61.6 Gy(alpha/beta10) and 74.9 Gy(alpha/beta10) for the high-risk clinical target volume, respectively. Of the 45 patients, 23 and 2 developed acute Grade 1-2 and Grade 3 complications, respectively; 21 patients presented with delayed Grade 1-2 complications. One other patient presented with Grade 3 vesicovaginal fistula. No Grade 4 or greater complications, whether acute or delayed, were observed.
Magnetic resonance imaging-guided PDR brachytherapy with optimization integrating the limits of tolerance to critical organs allows for excellent local control rates. Moreover, the present results have confirmed that the ability to optimize dwell times can contribute to an improvement in local control rates with a low level of late side effects.
评估三维磁共振成像引导下的脉冲剂量率（PDR）腔内近距离放射治疗对宫颈癌患者的物理贡献及临床疗效。
分析45例原发性局部晚期宫颈癌患者的数据。肿瘤宫颈体积中位数为64.0 cm³（范围3 - 178）。45例患者中，24例（53%）有组织学和/或影像学证实的盆腔受累。在进行盆腔伴或不伴腹主动脉旁同步放化疗后，根据关键器官的剂量体积限制及靶区覆盖优化情况，基于三维磁共振成像向临床靶区给予PDR近距离放射治疗强化剂量。
中位随访26个月（范围9 - 47个月）时，2年总生存率和无病生存率分别为78%和73%。在最后一次随访时，所有患者的疾病均保持局部控制。采用2-Gy分次等效剂量模型加入外照射放疗和PDR后，中危临床靶区100%和90%靶区接受的中位剂量分别为54.4 Gy（α/β = 10）和63.5 Gy（α/β = 10），高危临床靶区分别为61.6 Gy（α/β = 10）和74.9 Gy（α/β = 10）。45例患者中，分别有23例和2例出现1 - 2级和3级急性并发症；21例患者出现1 - 2级迟发性并发症。另有1例患者出现3级膀胱阴道瘘。未观察到4级或更高级别的急性或迟发性并发症。
磁共振成像引导下的PDR近距离放射治疗结合关键器官耐受极限进行优化，可实现优异的局部控制率。此外本研究结果证实，优化驻留时间的能力有助于提高局部控制率，且晚期副作用水平较低。
