Refaat Tamer, Castelain Bernard, Small William, Elsaid Amr, Lotfy Nashaat, Lartigau Eric, Nickers Philippe
*Département Universitaire de Radiothérapie, Centre Oscar Lambret, Lille, France †Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL ‡Department of Clinical Oncology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Am J Clin Oncol. 2015 Jun;38(3):289-93. doi: 10.1097/COC.0b013e31829c3009.
Concurrent chemoradiotherapy (CRT) is the standard of care for patients with bulky cervical cancer. This study aimed to determine the feasibility, tolerance, and effectiveness of pulsed dose rate (PDR) image-guided brachytherapy (IGBT), utilizing magnetic resonance imaging (MRI) planning after CRT for stages IB2 and II cervix cancer patients.
This study planned to include patients with histologically confirmed stage IB2 and II cervical cancer who were treated with CRT followed by a PDR IGBT boost from January 2009 to December 2009 in our institution. All patients had at least a partial response after CRT before IGBT. The institutional review board approved the study. Patients received a 45-Gy external beam radiotherapy (EBRT) to the pelvis with concomitant weekly cisplatin (40 mg/m) for 5 cycles. All patients then underwent reimaging using MRI before BT. The IGBT boost was accomplished with one insertion using an MRI-compatible tandem and ovoid applicator delivering 30 to 35 Gy to a high-risk clinical target volume. Treatment-induced adverse events (AEs), dose parameters, local control, progression-free survival, and overall survival are reported.
Forty patients were included in this study, with ages ranging from 31 to 65 years (median age, 45 y). Of all the patients, 12.5% and 5% experienced grade 3 to 4 acute gastrointestinal and genitourinary AEs, respectively, and 2.5% and 2.5% had grade 3 to 4 chronic gastrointestinal and genitourinary AEs, respectively. Within a median follow-up of 30 months (range, 7 to 40 mo), local control was 90%, progression-free survival was 87.5%, and overall survival was 100%.
Intracavitary MRI PDR-IGBT boost after CRT is a feasible, tolerable, and effective treatment modality for patients with stages IB2 and II cervical cancer.
同步放化疗（CRT）是局部晚期宫颈癌患者的标准治疗方案。本研究旨在确定脉冲剂量率（PDR）图像引导近距离放疗（IGBT）的可行性、耐受性和有效性，该放疗是在CRT后利用磁共振成像（MRI）为IB2期和II期宫颈癌患者制定计划。
本研究计划纳入2009年1月至2009年12月在我院接受CRT治疗后再接受PDR IGBT强化治疗的组织学确诊为IB2期和II期宫颈癌患者。所有患者在接受IGBT治疗前，CRT后至少有部分缓解。机构审查委员会批准了该研究。患者接受45 Gy的盆腔外照射放疗（EBRT），同时每周给予顺铂（40 mg/m²），共5个周期。所有患者在近距离放疗前均使用MRI进行重新成像。IGBT强化治疗通过一次插入使用与MRI兼容的串联和卵圆形施源器完成，向高危临床靶体积给予30至35 Gy的剂量。报告了治疗引起的不良事件（AE）、剂量参数、局部控制、无进展生存期和总生存期。
本研究纳入了40例患者，年龄在31至65岁之间（中位年龄45岁）。在所有患者中，分别有12.5%和5%经历了3至4级急性胃肠道和泌尿生殖系统AE，分别有2.5%和2.5%出现了3至4级慢性胃肠道和泌尿生殖系统AE。在中位随访30个月（范围7至40个月）内，局部控制率为90%，无进展生存率为87.5%，总生存率为100%。
CRT后腔内MRI PDR-IGBT强化治疗对于IB2期和II期宫颈癌患者是一种可行、可耐受且有效的治疗方式。
