Yoshida Kenji, Jastaniyah Noha, Sturdza Alina, Lindegaard Jacob, Segedin Barbara, Mahantshetty Umesh, Rai Bhavana, Jürgenliemk-Schulz Ina, Haie-Meder Christine, Sasaki Ryohei, Pötter Richard
Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria; Kobe University Graduate School of Medicine, Kobe, Japan.
Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria; King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Int J Radiat Oncol Biol Phys. 2015 Nov 15;93(4):788-96. doi: 10.1016/j.ijrobp.2015.08.007. Epub 2015 Aug 7.
To assess disease response along the parametrial space according to tumor morphology in patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIB and IIIB cervical cancer at the time of image-guided adaptive brachytherapy.
Patients with FIGO stage IIB and IIIB cervical cancer registered as of November 2013 in the EMBRACE study were evaluated. Tumors were stratified according to morphologic subtype on magnetic resonance imaging (expansive and infiltrative), and the characteristics of those subtypes were analyzed. Parametrial involvement at diagnosis and at brachytherapy was evaluated, and the response to chemo-radiotherapy was classified as good, moderate, or poor. The response grade was compared between the 2 groups and analyzed with regard to tumor volumes, and dosimetric parameters.
A total of 452 patients were evaluated, of whom 186 had expansive growth type and 266 had infiltrative morphology. Patients with infiltrative tumors had more extensive disease, as indicated by a higher rate of FIGO stage IIIB disease, as well as radiologic evidence of extension into the distal parametrial space and to the pelvic side wall on magnetic resonance imaging. Cervical necrosis was more common in the infiltrative group. Good response was more common in the expansive group (34% vs 24%; P=.02), and poor response was more common in the infiltrative group (11% and 19%; P=.02). Mean gross tumor volume at diagnosis was equal in both groups (51.7 cm(3)). The high-risk clinical target volume was larger in infiltrative tumors (37.9 cm(3) vs 33.3 cm(3), P=.005). The mean high-risk clinical target volume D90 was slightly higher in expansive tumors (92.7 Gy and 89.4 Gy, P<.001).
Infiltrative tumors are more advanced at presentation and respond less favorably to chemo-radiotherapy when compared with expansive tumors that are more or less equivalent in size. The use of image-guided adaptive brachytherapy allows achieving reasonably high doses in both groups.
评估国际妇产科联盟（FIGO）IIB期和IIIB期宫颈癌患者在图像引导下的适应性近距离放射治疗时，根据肿瘤形态在宫旁间隙的疾病反应。
对截至2013年11月在EMBRACE研究中登记的FIGO IIB期和IIIB期宫颈癌患者进行评估。根据磁共振成像（MRI）上的形态学亚型（膨胀性和浸润性）对肿瘤进行分层，并分析这些亚型的特征。评估诊断时和近距离放射治疗时的宫旁受累情况，并将放化疗反应分为良好、中等或较差。比较两组之间的反应等级，并就肿瘤体积和剂量学参数进行分析。
共评估了452例患者，其中186例为膨胀性生长型，266例为浸润性形态。浸润性肿瘤患者的疾病范围更广，表现为FIGO IIIB期疾病发生率更高，以及MRI上有延伸至远端宫旁间隙和盆腔侧壁的影像学证据。宫颈坏死在浸润性组中更常见。良好反应在膨胀性组中更常见（34%对24%；P = 0.02），而较差反应在浸润性组中更常见（11%和19%；P = 0.02）。两组诊断时的平均肿瘤总体积相等（51.7 cm³）。浸润性肿瘤的高危临床靶体积更大（37.9 cm³对33.3 cm³，P = 0.005）。膨胀性肿瘤的平均高危临床靶体积D90略高（92.7 Gy和89.4 Gy，P < 0.001）。
与大小大致相当的膨胀性肿瘤相比，浸润性肿瘤在就诊时病情更晚期，对放化疗的反应较差。图像引导下的适应性近距离放射治疗的应用使两组都能达到相当高的剂量。
