Gaztañaga Miren, Cambeiro Mauricio, Villafranca Elena, Vila Meritxell, Jurado Matías, Moreno Marta, Martínez-Monge Rafael
Department of Oncology, University Clinic of Navarre, University of Navarre, Avda Pío XII s/n, Pamplona, Navarre, Spain.
Brachytherapy. 2012 Mar-Apr;11(2):119-24. doi: 10.1016/j.brachy.2011.05.004.
To compare the biologic equivalence in terms of local control and toxicity of a short course of high-dose-rate intravaginal brachytherapy alone (IVBa) delivered over five consecutive days (25 Gy/5 Rx/5 days) to other more protracted classical schemes 21 Gy/3 Rx/14-28 days (Postoperative Radiation Therapy in Endometrial Carcinoma [PORTEC]-2/Memorial Sloan-Kettering Cancer Center).
From February 2001 to May 2008, 122 patients with International Federation of Gynecology and Obstetrics Stage IaG3-IIIaG2 endometrial adenocarcinoma were treated with total abdominal hysterectomy and bilateral salpingo-oophorectomy followed by postoperative IVBa. Seventy-seven patients (63.1%) underwent surgical staging. Total IVBa dose was 25Gy in five consecutive daily fractions prescribed at 0.5-cm depth.
After a median followup of 4.1 years, the rates of Radiation Therapy Oncology Group Grades 1, 2, and ≥3 complications were 12.9%, 3.4%, and 0.8%, respectively. Five patients (4.1%) presented locoregional failures: two isolated nodal pelvic failures, one vaginal pelvic relapse (intra-abdominal lymph node metastases), one vaginal distant failure, and one combined locoregional and distant failure. The 8.5-year actuarial vaginal control rate was 97.5%, and the pelvic control rate was 94.3%. Six other patients developed distant metastases alone. The 8.5-year actuarial overall and disease-free survival rates were 90.3% and 87.2%, respectively. Univariate analysis revealed that histologic grade, deep myometrial invasion, advanced age, and categorization as high intermediate-risk patient according to the PORTEC-2 and the Gynecologic Oncology Group (GOG)-99 stratifications were statistically significant prognostic factors. After multivariate analysis, histologic grade (p=0.001) and high intermediate risk according to GOG-99 (p=0.004) and PORTEC-2 (p=0.001) remained significant.
The proposed scheme reproduces the excellent results obtained with more protracted schemes and has the added advantage of shortened overall treatment time.
比较连续5天给予短疗程高剂量率阴道近距离放疗（IVBa，25Gy/5次/5天）与其他更延长的经典方案（21Gy/3次/14 - 28天，子宫内膜癌术后放疗[PORTEC]-2/纪念斯隆凯特琳癌症中心）在局部控制和毒性方面的生物学等效性。
2001年2月至2008年5月，122例国际妇产科联盟分期为IaG3 - IIIaG2的子宫内膜腺癌患者接受了全腹子宫切除术及双侧输卵管卵巢切除术，随后进行术后IVBa治疗。77例患者（63.1%）接受了手术分期。IVBa总剂量为25Gy，分5次连续每日给予，处方深度为0.5cm。
中位随访4.1年后，放射肿瘤学组1级、2级和≥3级并发症发生率分别为12.9%、3.4%和0.8%。5例患者（4.1%）出现局部区域复发：2例孤立性盆腔淋巴结复发，1例阴道盆腔复发（腹内淋巴结转移），1例阴道远处复发，1例局部区域和远处联合复发。8.5年精算阴道控制率为97.5%，盆腔控制率为94.3%。另外6例患者仅发生远处转移。8.5年精算总生存率和无病生存率分别为90.3%和87.2%。单因素分析显示，组织学分级、肌层深部浸润、高龄以及根据PORTEC-2和妇科肿瘤学组（GOG）-99分层归类为高中风险患者是具有统计学意义的预后因素。多因素分析后，组织学分级（p = 0.001）以及根据GOG-99（p = 0.004）和PORTEC-2（p = 0.001）分类的高中风险仍具有显著性。
所提出的方案再现了更延长方案所获得的优异结果，并且具有缩短总体治疗时间的额外优势。
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