宫颈癌根治术及盆腔淋巴结清扫术后伴腹膜后淋巴结转移的同步调制加速放疗

Simultaneous modulated accelerated radiotherapy in cervical cancer with retroperitoneal lymph node metastasis after radical hysterectomy and pelvic lymphadenectomy.

作者信息

Li Xing-lan, Chen Zhen-yun, Cui Yong-chun, Sheng Xui-gui

机构信息

*Department of Gynecologic Oncology, Shandong Cancer Hospital and Institute, Jinan, People's Republic of China; †School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, People's Republic of China; ‡Department of Gynecologic Oncology, Linyi Tumor Hospital, Linyi, People's Republic of China; and §Department of Education, Shandong Cancer Hospital and Institute, Jinan, People's Republic of China.

出版信息

Int J Gynecol Cancer. 2015 Jun;25(5):903-9. doi: 10.1097/IGC.0000000000000426.

DOI:10.1097/IGC.0000000000000426

PMID:25822099

Abstract

OBJECTIVE

To compare the dosimetry, toxicity, and efficacy of simultaneous modulated accelerated radiotherapy (SMART) with 3-dimensional conformal radiotherapy (3DCRT) in cervical cancer with retroperitoneal lymph node metastasis after radical hysterectomy and pelvic lymphadenectomy.

METHODS

Total 32 patients who underwent SMART were retrospectively evaluated. Daily fractions of 2.2 to 2.4 Gy and 1.8 to 2 Gy were prescribed and delivered to gross tumor volume and clinical target volume to a total dose of 63.8 and 52.2 Gy, respectively. A 3DCRT plan was designed for the SMART group and planned to deliver the same prescribed dose. The doses of organs at risk (OARs) were compared. Thirty-six patients who received 3DCRT were used to compare the target dose, toxicities, and efficacy with 32 cases who received SMART.

RESULTS

The mean doses delivered to gross tumor volume and clinical target volume were significantly higher in the SMART group than in the 3DCRT group (63.8 vs 55.2 Gy [P < 0.01] and 52.5 vs 48.6 Gy [P < 0.01], respectively). For SMART plan, the doses of OARs were significantly lower than that of 3DCRT plans (small intestine: 25.1 vs 30.9 Gy [P < 0.01], bladder: 35.3 vs 46.3 [P < 0.01], and rectum: 31.7 vs 43.7 [P = 0.002], respectively). The patients experienced less acute and late toxicities in the SMART group (acute toxicities: enteroproctitis, P = 0.019; cystitis, P = 0.013; leukopenia, P = 0.025; late toxicities: enteroproctitis, P = 0.007; and cystitis, P = 0.026, respectively). No significant difference was found for 1-year survival (78.7% vs 67.7%, P = 0.222), but SMART group had a higher 2-year survival rate (2-year: 63.1% vs 39.1%, P = 0.029).

CONCLUSIONS

Simultaneous modulated accelerated radiotherapy plans yielded higher dose to the targets and better sparing of OARs than did 3DCRT in cervical cancer with retroperitoneal lymph node metastasis after radical hysterectomy and pelvic lymphadenectomy. Simultaneous modulated accelerated radiotherapy provided better clinical outcomes than did 3DCRT. Long-term follow-up and studies involving more patients are needed to confirm our results.

摘要

目的

比较同步调强加速放疗（SMART）与三维适形放疗（3DCRT）在根治性子宫切除和盆腔淋巴结清扫术后发生腹膜后淋巴结转移的宫颈癌患者中的剂量学、毒性和疗效。

方法

回顾性评估32例行SMART的患者。分别给予大体肿瘤体积和临床靶体积每日分次剂量2.2至2.4 Gy和1.8至2 Gy，总剂量分别为63.8 Gy和52.2 Gy。为SMART组设计3DCRT计划，并计划给予相同的处方剂量。比较危及器官（OARs）的剂量。36例接受3DCRT的患者用于与32例接受SMART的患者比较靶剂量、毒性和疗效。

结果

SMART组给予大体肿瘤体积和临床靶体积的平均剂量显著高于3DCRT组（分别为63.8 vs 55.2 Gy [P < 0.01]和52.5 vs 48.6 Gy [P < 0.01]）。对于SMART计划，OARs的剂量显著低于3DCRT计划（小肠：25.1 vs 30.9 Gy [P < 0.01]，膀胱：35.3 vs 46.3 [P < 0.01]，直肠：31.7 vs 43.7 [P = 0.002]）。SMART组患者的急性和晚期毒性较小（急性毒性：肠炎，P = 0.019；膀胱炎，P = 0.013；白细胞减少，P = 0.025；晚期毒性：肠炎，P = 0.007；膀胱炎，P = 0.026）。1年生存率无显著差异（78.7% vs 67.7%，P = 0.222），但SMART组的2年生存率较高（2年：63.1% vs 39.1%，P = 0.029）。