Boyrie Sabrina, Charra-Brunaud Claire, Harter Valentin, Ducassou Anne, Kirova Youlia, Barillot Isabelle, Krzisch Claude, Lang Philippe, Baron Marie-Hélène, Montbarbon Xavier, Delannes Martine, Peiffert Didier
Department of Radiotherapy, Institut Claudius Regaud, Toulouse, France.
Department of Radiotherapy, Centre Alexis-Vautrin, Vandoeuvre-les-Nancy, France.
Brachytherapy. 2014 Jul-Aug;13(4):326-31. doi: 10.1016/j.brachy.2014.03.003.
To investigate the impact of dose-volume histograms parameters on local control of three-dimensional (3D) image-based pulsed dose-rate brachytherapy (BT).
Within a French multicentric prospective study, the data of the 110 patients treated for cervical cancer with external beam radiotherapy followed by 3D image-based and optimized pulsed dose-rate BT were analyzed. Delineation procedures were performed on magnetic resonance imaging in a minority of cases and on CT for the majority of cases, adapted from the Gynaecological Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology recommendations. Optimization procedure was left to the discretion of the treating center.
At 2 years, local control rate reached 78%. Dose to Point A, total reference air kerma, and intermediate-risk clinical target volume (IR-CTV) V60 were predictive factors for local control (p = 0.001, p = 0.001, and p = 0.013, respectively). Patients with IR-CTV V60 <75% had a relative risk of local recurrence of 3.8 (95% confidence interval, 1.4-11.1). There was no correlation found between the high-risk clinical target volume dosimetric parameters and local control.
This multicentric study has shown that 3D image-based BT provides a high local control rate for cervical cancer patients. The V60 for IR-CTV was identified as an important predictive factor for local control.
研究剂量体积直方图参数对基于三维（3D）图像的脉冲剂量率近距离放射治疗（BT）局部控制的影响。
在一项法国多中心前瞻性研究中，分析了110例宫颈癌患者的数据，这些患者先接受外照射放疗，随后接受基于3D图像的优化脉冲剂量率BT治疗。少数病例在磁共振成像上进行轮廓勾画，大多数病例在CT上进行，这是根据欧洲妇科放射治疗协作组-欧洲放射治疗与肿瘤学会的建议进行调整的。优化程序由治疗中心自行决定。
2年时，局部控制率达到78%。A点剂量、总参考空气比释动能和中危临床靶体积（IR-CTV）的V60是局部控制的预测因素（分别为p = 0.001、p = 0.001和p = 0.013）。IR-CTV V60<75%的患者局部复发的相对风险为3.8（95%置信区间，1.4 - 11.1）。未发现高危临床靶体积剂量学参数与局部控制之间存在相关性。
这项多中心研究表明，基于3D图像的BT为宫颈癌患者提供了较高的局部控制率。IR-CTV的V60被确定为局部控制的重要预测因素。
