Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
Int J Radiat Oncol Biol Phys. 2012 May 1;83(1):185-90. doi: 10.1016/j.ijrobp.2011.05.053. Epub 2011 Oct 17.
To determine the patterns of failure in patients with cervical cancer treated with definitive radiotherapy and evaluated for metabolic response with early posttherapy (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET).
The records of 238 patients with cervical cancer were reviewed. All patients were treated with a combination of external radiotherapy and intracavitary brachytherapy. Two hundred and nineteen patients (92%) received concurrent chemotherapy. All patients underwent pretreatment FDG-PET, and posttherapy FDG-PET was performed within 8-16 weeks of the completion of radiotherapy. Posttherapy FDG-PET results were categorized as complete metabolic response (CMR), partial metabolic response (PMR), and progressive disease (PD). Failure patterns were categorized as none, isolated local failure (central pelvis ± pelvic lymph nodes), distant failure, or combined local plus distant failure.
Of the 91 patients (38%) who had a recurrence, 22 had isolated local failures, and 69 had distant failures (49 distant failures and 20 combined local plus distant failures). Of the 173 patients with a CMR, 40 (23%) experienced treatment failure. All 25 patients with PD experienced treatment failure, which was distant in 24 patients (96%). Among the 40 patients with PMR, no failure has been observed for 14 patients (35%). Of the 26 failures within the PMR group, 15 (58%) were limited to the pelvis. Differences in the patterns of failure between the three groups (CMR, PMR, PD) were statistically significant (chi-square test; p < 0.0001).
The majority of failures after definitive radiotherapy for cervical cancer include distant failures, even in the setting of concurrent chemotherapy. PMR within the cervix or lymph nodes is more commonly associated with isolated local recurrence.
通过早期治疗后（18）F-氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）评估代谢反应，确定接受根治性放疗的宫颈癌患者的失败模式。
对 238 例宫颈癌患者的记录进行了回顾性分析。所有患者均采用外照射放疗和腔内近距离放疗联合治疗。219 例患者（92%）接受了同期化疗。所有患者均进行了治疗前 FDG-PET 检查，放疗结束后 8-16 周内行治疗后 FDG-PET 检查。将治疗后 FDG-PET 结果分为完全代谢反应（CMR）、部分代谢反应（PMR）和进展性疾病（PD）。失败模式分为无、孤立局部失败（中央骨盆±盆腔淋巴结）、远处失败或局部加远处联合失败。
在 91 例（38%）复发的患者中，22 例为孤立局部失败，69 例为远处失败（49 例远处失败和 20 例局部加远处联合失败）。173 例 CMR 患者中有 40 例（23%）发生治疗失败。25 例 PD 患者均发生治疗失败，其中 24 例（96%）为远处转移。40 例 PMR 患者中，14 例（35%）无复发。在 PMR 组的 26 例失败中，15 例（58%）局限于骨盆。三组（CMR、PMR、PD）失败模式存在差异，具有统计学意义（卡方检验；p<0.0001）。
根治性放疗后宫颈癌的失败模式主要为远处失败，即使在同期化疗的情况下也是如此。宫颈或淋巴结内的 PMR 更常与孤立的局部复发相关。
