Department of Radiation Oncology, University of California Davis Medical Center, Sacramento, California, USA.
Int J Radiat Oncol Biol Phys. 2013 Oct 1;87(2):317-22. doi: 10.1016/j.ijrobp.2013.06.2031. Epub 2013 Jul 29.
Optimal treatment with radiation for metastatic lymphadenopathy in locally advanced cervical cancer remains controversial. We investigated the clinical dose response threshold for pelvic and para-aortic lymph node boost using radiographic imaging and clinical outcomes.
Between 2007 and 2011, 68 patients were treated for locally advanced cervical cancer; 40 patients had clinically involved pelvic and/or para-aortic lymph nodes. Computed tomography (CT) or 18F-labeled fluorodeoxyglucose-positron emission tomography scans obtained pre- and postchemoradiation for 18 patients were reviewed to assess therapeutic radiographic response of individual lymph nodes. External beam boost doses to involved nodes were compared to treatment response, assessed by change in size of lymph nodes by short axis and change in standard uptake value (SUV). Patterns of failure, time to recurrence, overall survival (OS), and disease-free survival (DFS) were determined.
Sixty-four lymph nodes suspicious for metastatic involvement were identified. Radiation boost doses ranged from 0 to 15 Gy, with a mean total dose of 52.3 Gy. Pelvic lymph nodes were treated with a slightly higher dose than para-aortic lymph nodes: mean 55.3 Gy versus 51.7 Gy, respectively. There was no correlation between dose delivered and change in size of lymph nodes along the short axis. All lymph nodes underwent a decrease in SUV with a complete resolution of abnormal uptake observed in 68%. Decrease in SUV was significantly greater for lymph nodes treated with ≥54 Gy compared to those treated with <54 Gy (P=.006). Median follow-up was 18.7 months. At 2 years, OS and DFS for the entire cohort were 78% and 50%, respectively. Locoregional control at 2 years was 84%.
A biologic response, as measured by the change in SUV for metastatic lymph nodes, was observed at a dose threshold of 54 Gy. We recommend that involved lymph nodes be treated to this minimum dose.
对于局部晚期宫颈癌转移淋巴结，放射治疗的最佳方案仍存在争议。我们通过影像学和临床结果研究了盆腔和腹主动脉旁淋巴结推量的临床剂量反应阈值。
2007 年至 2011 年间，68 例局部晚期宫颈癌患者接受治疗；40 例患者的盆腔和/或腹主动脉旁淋巴结受累。对 18 例患者的化疗后盆腔和腹主动脉旁淋巴结的 CT 或 18F 标记氟代脱氧葡萄糖正电子发射断层扫描（PET）进行回顾性分析，以评估淋巴结的治疗后放射学反应。将累及淋巴结的外照射推量剂量与治疗反应进行比较，通过短轴淋巴结大小的变化和标准摄取值（SUV）的变化来评估。确定失败模式、复发时间、总生存期（OS）和无病生存期（DFS）。
共发现 64 个可疑转移受累的淋巴结。放射治疗推量剂量范围为 0 至 15 Gy，总剂量平均为 52.3 Gy。盆腔淋巴结的治疗剂量略高于腹主动脉旁淋巴结：分别为 55.3 Gy 和 51.7 Gy。给予的剂量与短轴淋巴结大小的变化之间没有相关性。所有淋巴结的 SUV 均下降，68%的淋巴结异常摄取完全消退。SUV 下降幅度在接受≥54 Gy 治疗的淋巴结与接受<54 Gy 治疗的淋巴结之间存在显著差异（P=.006）。中位随访时间为 18.7 个月。2 年时，全组的 OS 和 DFS 分别为 78%和 50%。2 年时局部区域控制率为 84%。
在 54 Gy 的剂量阈值下，观察到转移性淋巴结的生物反应，即 SUV 的变化。我们建议将受累淋巴结治疗至这个最低剂量。
