Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
Gynecol Oncol. 2013 Dec;131(3):586-92. doi: 10.1016/j.ygyno.2013.08.040. Epub 2013 Sep 9.
To evaluate clinical outcomes for women with recurrent endometrial cancer treated with 3D image-guided brachytherapy
44 women, of whom 13 had received prior RT, received salvage RT for vaginal recurrence from 9/03 to 8/11. HDR or LDR interstitial brachytherapy was performed under MR or CT guidance in 35 patients (80%); 9 (20%) had CT-guided HDR cylinder brachytherapy. The median cumulative dose in EQD2 was 75.5 Gy. Actuarial estimates of local failure (LF), disease-free (DFS) and overall survival (OS) were calculated by Kaplan-Meier.
Histologic subtypes were endometrioid (EAC, 33), papillary serous/clear cell (UPSC/CC, 5) and carcinosarcoma (CS, 6). The 2-year DFS/OS rates were 75%/89% for EAC and 11%/24% for UPSC/CC/CS (both p<0.01). On MVA, high tumor grade was associated with recurrence (HR 3.2 for grade 2, 9.6 for grade 3, p<0.01). The LF rate at 2 years was 4% for patients without versus 39% for those with prior RT (p=0.1). Patients who had prior RT received lower cumulative doses at recurrence (66.5 Gy vs. 74.4 Gy, p<0.01). The 2-year DFS/OS rates with and without prior RT were 26%/55% and 72%/80% (both p=0.1). Four patients (9%) experienced grade 3 late toxicity, including 3 of 13 (23%) in the re-irradiation setting and 1 of 31 (3%) with no prior radiotherapy.
3D image-guided brachytherapy results in excellent local control for women with recurrent endometrial cancer, particularly with cumulative EQD2 doses greater than 70 Gy. Successful salvage of vaginal recurrence is related to tumor grade and histologic subtype.
评估 3D 图像引导近距离放疗治疗复发性子宫内膜癌患者的临床结果。
44 名女性患者，其中 13 名患者曾接受过放疗，于 2003 年 9 月至 2011 年 8 月接受阴道复发的挽救性放疗。35 名患者（80%）在磁共振或 CT 引导下进行了 HDR 或 LDR 间质近距离放疗；9 名患者（20%）接受了 CT 引导的 HDR 圆柱状近距离放疗。EQD2 累积剂量中位数为 75.5Gy。通过 Kaplan-Meier 计算局部失败（LF）、无疾病（DFS）和总生存（OS）的累积发生率。
组织学类型为子宫内膜样腺癌（EAC，33 例）、乳头状浆液性/透明细胞癌（UPSC/CC，5 例）和癌肉瘤（CS，6 例）。EAC 患者的 2 年 DFS/OS 率为 75%/89%，UPSC/CC/CS 患者为 11%/24%（均 P<0.01）。多变量分析显示，肿瘤分级高与复发相关（2 级为 3.2，3 级为 9.6，均 P<0.01）。无既往放疗患者的 2 年 LF 率为 4%，而有既往放疗患者为 39%（P=0.1）。有既往放疗的患者在复发时接受的累积剂量较低（66.5Gy 比 74.4Gy，P<0.01）。有和无既往放疗的患者的 2 年 DFS/OS 率分别为 26%/55%和 72%/80%（均 P=0.1）。4 名患者（9%）发生 3 级晚期毒性，其中 13 名接受再放疗的患者中有 3 名（23%），31 名未接受放疗的患者中有 1 名（3%）。
3D 图像引导近距离放疗为复发性子宫内膜癌患者提供了极佳的局部控制效果，特别是累积 EQD2 剂量大于 70Gy。阴道复发的成功挽救与肿瘤分级和组织学类型有关。
