Department of Radiation Oncology, Julius-Maximilians University, Wuerzburg, Germany.
Radiother Oncol. 2010 Jan;94(1):53-9. doi: 10.1016/j.radonc.2009.12.004. Epub 2010 Jan 14.
To evaluate outcome of radiotherapy for locally recurrent cervical and endometrial cancer.
Nineteen patients were treated for a locally recurrent cervical (n=12) or endometrial (n=7) cancer median 26 months after initial surgery (n=18) or radiotherapy (n=1). The whole pelvis was irradiated with 50Gy conventionally fractionated radiotherapy (n=16). Because of large size of the recurrent cancer (median 4.5 cm) and peripheral location (n=12), stereotactic body radiotherapy (SBRT; median 3 fractions of 5Gy to 65%) was used for local dose escalation instead of (n=16) or combined with (n=3) vaginal brachytherapy.
After median follow-up of 22 months, 3-year overall survival was 34% with systemic progression the leading cause of death (7/10). Median time to systemic progression was 16 months. Three local recurrences resulted in a local control rate of 81% at 3 years. No correlation between survival, systemic or local control and any patient or treatment characteristic was observed. The rate of late toxicity>grade II was 25% at 3 years: two patients developed a grade IV intestino-vaginal fistula and one patient suffered from a grade IV small bowel ileus.
Image-guided SBRT for local dose escalation resulted in high rates of local control but was associated with significant late toxicity.
评估局部复发性宫颈癌和子宫内膜癌的放疗结果。
19 名患者因局部复发性宫颈癌（n=12）或子宫内膜癌（n=7）接受治疗，这些患者在初始手术（n=18）或放疗（n=1）后中位时间为 26 个月。16 名患者采用常规分割放疗，全骨盆照射 50Gy。由于复发性癌症（中位数为 4.5cm）和外周位置（n=12）较大，立体定向体部放疗（SBRT；中位数 3 次 5Gy 至 65%）用于局部剂量升级，而非（n=16）或联合（n=3）阴道近距离放疗。
中位随访 22 个月后，3 年总生存率为 34%，全身进展是死亡的主要原因（7/10）。中位至全身进展时间为 16 个月。3 例局部复发导致 3 年局部控制率为 81%。未观察到生存、全身或局部控制与任何患者或治疗特征之间存在相关性。3 年后晚期毒性>2 级的发生率为 25%：2 例发生 4 级肠-阴道瘘，1 例发生 4 级小肠肠梗阻。
图像引导 SBRT 用于局部剂量升级可获得较高的局部控制率，但与显著的晚期毒性相关。
