Department of Radiation Oncology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO; Department of Cell Biology and Physiology, Mallinckrodt Institute of Radiology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO 63110, USA.
Int J Radiat Oncol Biol Phys. 2011 Dec 1;81(5):1258-63. doi: 10.1016/j.ijrobp.2010.07.038. Epub 2010 Oct 6.
To investigate, in a prospective trial, the acute and chronic toxicity of patients with cervical cancer treated with surgery and postoperative intensity-modulated radiotherapy (RT) delivered using helical tomotherapy, with or without the administration of concurrent chemotherapy.
A total of 24 evaluable patients entered the study between March 2006 and August 2009. The indications for postoperative RT were tumor size, lymphovascular space invasion, and the depth of cervical stromal invasion in 15 patients; 9 patients underwent postoperative RT because of surgically positive lymph nodes. All patients underwent pelvic RT delivered with helical tomotherapy and intracavitary high-dose-rate brachytherapy. Treatment consisted of concurrent weekly platinum in 17, sequential carboplatin/Taxol in 1, and RT alone in 6. The patients were monitored for acute and chronic toxicity using the Common Toxicity Criteria, version 3.0.
The median follow-up was 24 months (range, 4-49). At the last follow-up visit, 23 patients were alive and disease free. Of the 24 patients, 12 (50%) experienced acute Grade 3 gastrointestinal toxicity (anorexia in 5, diarrhea in 4, and nausea in 3). One patient developed acute Grade 4 genitourinary toxicity (vesicovaginal fistula). For patients treated with concurrent chemotherapy, the incidence of acute Grade 3 and 4 hematologic toxicity was 71% and 24%, respectively. For patients treated without concurrent chemotherapy, the incidence of acute Grade 3 and 4 hematologic toxicity was 29% and 14%, respectively. Two long-term toxicities occurred (vesicovaginal fistula at 25 months and small bowel obstruction at 30 months). The overall and progression-free survival rate at 3 years for all patients was 100% and 89%, respectively.
The results of our study have shown that postoperative external RT for cervical cancer delivered with helical tomotherapy and high-dose-rate brachytherapy and with or without chemotherapy is feasible, with acceptable acute and chronic toxicity.
前瞻性研究宫颈癌患者术后采用螺旋断层放疗（tomotherapy）进行强度调制放疗（IMRT）及同期放化疗的急性和慢性毒性。
2006 年 3 月至 2009 年 8 月共 24 例可评估患者入组本研究。术后放疗的指征为 15 例患者的肿瘤大小、脉管间隙浸润和宫颈间质浸润深度；9 例患者因手术阳性淋巴结而行术后放疗。所有患者均采用螺旋断层放疗联合腔内高剂量率近距离放疗进行盆腔放疗。治疗包括 17 例每周顺铂同期放化疗、1 例卡铂/紫杉醇序贯放化疗和 6 例单纯放疗。采用通用毒性标准 3.0 对急性和慢性毒性进行监测。
中位随访时间为 24 个月（4-49 个月）。末次随访时，23 例患者存活且无疾病。24 例患者中，12 例（50%）出现急性 3 级胃肠道毒性（厌食 5 例，腹泻 4 例，恶心 3 例）。1 例发生急性 4 级泌尿生殖系统毒性（膀胱阴道瘘）。接受同期化疗的患者急性 3 级和 4 级血液学毒性的发生率分别为 71%和 24%。未接受同期化疗的患者急性 3 级和 4 级血液学毒性的发生率分别为 29%和 14%。发生 2 例长期毒性反应（25 个月时出现膀胱阴道瘘，30 个月时出现小肠梗阻）。所有患者的 3 年总生存率和无进展生存率分别为 100%和 89%。
本研究结果表明，宫颈癌术后采用螺旋断层放疗和高剂量率近距离放疗联合或不联合化疗进行外照射是可行的，具有可接受的急性和慢性毒性。
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