调强放疗治疗化疗耐药的复发性卵巢癌。

Intensity modulated radiation therapy for recurrent ovarian cancer refractory to chemotherapy.

机构信息

Department of Radiation Oncology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.

Department of Obstetrics and Gynecology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.

出版信息

Gynecol Oncol. 2016 Apr;141(1):134-9. doi: 10.1016/j.ygyno.2016.02.005. Epub 2016 Feb 10.

DOI:10.1016/j.ygyno.2016.02.005

PMID:26876923

Abstract

OBJECTIVE

To evaluate local control, survival outcomes, and toxicity after intensity modulated radiotherapy (IMRT) for recurrent chemorefractory ovarian cancer.

METHODS

Between 2006 and 2014, 33 patients were treated with IMRT for recurrent ovarian cancer. Patients received a median of 3 chemotherapy regimens prior to IMRT (range, 1-12) with 11 (33%) undergoing concurrent therapy. Local control (LC), recurrence free survival (RFS), and overall survival (OS) were calculated via Kaplan-Meier method. Toxicity was assessed using the Common Terminology Criteria for Adverse Events (CTCAE) v4.03. Impact of patient characteristics on outcomes was evaluated via Cox's proportional hazard model.

RESULTS

Median follow up was 23.7 months. Forty-nine sites were treated to a median dose of 5040cGy (range, 4500-7000). Nine (18%) of the 49 sites had in-field failures. Two year actuarial LC, RFS, and OS were 82%, 11%, and 63%, respectively. Seventeen patients had both a pre and post-treatment FDG-PET/CT; 6 (35%) had a complete metabolic response while 11 (65%) had a partial metabolic response. Acute ≥ grade 3 gastrointestinal (GI) toxicities occurred in 2 (6%) patients, late ≥ grade 3 GI toxicities occurred in 12 (36%), acute ≥ grade 3 hematological toxicities occurred in 5 (15%) and late ≥ grade 3 hematological toxicities occurred in 14 (42%).

CONCLUSIONS

IMRT for recurrent chemorefractory ovarian cancer is associated with excellent local control and limited radiation related toxicity. Future studies will be required to determine which subpopulation will benefit most from IMRT and whether alternative techniques such as stereotactic body radiotherapy may be feasible.

摘要

目的

评估复发性化疗耐药卵巢癌调强放疗（IMRT）后的局部控制、生存结果和毒性。

方法

2006 年至 2014 年，33 例复发性卵巢癌患者接受 IMRT 治疗。患者在接受 IMRT 前接受中位数为 3 种化疗方案（范围 1-12），其中 11 例（33%）同时接受治疗。通过 Kaplan-Meier 方法计算局部控制（LC）、无复发生存（RFS）和总生存（OS）。使用通用不良事件术语标准（CTCAE）v4.03 评估毒性。通过 Cox 比例风险模型评估患者特征对结果的影响。

结果

中位随访时间为 23.7 个月。49 个部位接受中位数剂量为 5040cGy（范围 4500-7000）的照射。49 个部位中有 9 个（18%）发生了场内失败。2 年总生存率、RFS 和 OS 分别为 82%、11%和 63%。17 例患者均进行了治疗前后的 FDG-PET/CT 检查；6 例（35%）完全代谢缓解，11 例（65%）部分代谢缓解。2 例（6%）患者出现急性≥3 级胃肠道（GI）毒性，12 例（36%）患者出现晚期≥3 级 GI 毒性，5 例（15%）患者出现急性≥3 级血液学毒性，14 例（42%）患者出现晚期≥3 级血液学毒性。