Oh Dongryul, Huh Seung Jae, Park Won, Ju Sang Gyu, Nam Heerim, Lee Jeong Eun
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Department of Radiation Oncology, Kangbuk Samsung Hospital, Seoul, Korea Department of Radiation Oncology, Kyungpook National University School of Medicine, Daegu, Korea.
Medicine (Baltimore). 2016 Jun;95(25):e3895. doi: 10.1097/MD.0000000000003895.
The aim of the study was to evaluate the treatment outcomes in cervical cancer patients treated with 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT)-guided 3-dimensional brachytherapy (3D-BT) planning for the first brachytherapy session.We retrospectively analyzed 87 patients with cervical cancer who received definitive radiotherapy (RT). Primary tumor size was ≤4 cm in 22 patients (25.3%), >4 cm and ≤6 cm in 45 patients (51.7%), and >6 cm in 20 patients (23.0%). The median total dose of external beam RT was 50.4 (50.4-60.4) Gy. FDG-PET/CT-guided 3D-BT with an iridium-192 source was performed. The clinical target volume (CTV) for 3D-BT included the entire cervix and the abnormal FDG-uptake with a 1-cm expansion. A planned total dose was 24 Gy at 4 Gy per insertion 3 times per week using a tandem and 2 ovoids.The mean D95 and D90 for the CTV were 73.4 (±5.9) Gy and 77.9 (±6.9) Gy, respectively (EQD2, α/β=10). The D2cc for the rectum and bladder was 374 (±97.4) cGy and 394 (±107.6) cGy per fraction, respectively. The EQD2 (α/β=3) for the D2cc was 74.5 (±12.4) Gy for the rectum and 77.3 (±14.6) Gy for the bladder. The median follow-up period was 40 (8-61) months. The 3-year overall survival (OS), progression-free survival (PFS), and local control (LC) rates were 84.7%, 72.1%, and 89.2%, respectively. The 3-year LC rate was 100% for tumors ≤ 4 cm, 91.1% for tumors > 4 cm and ≤ 6 cm, and 70.5% for tumors > 6 cm (P = 0.014). Local failure developed in 9 patients. Three patients had local failures outside of the CTV. Grade 1, 2, and 3 rectal bleeding developed in 5, 4, and 2 patients, respectively. One patient experienced rectovaginal fistula.FDG-PET/CT-guided 3D-BT planning is a feasible approach, which showed favorable clinical outcomes.
本研究的目的是评估接受¹⁸F-氟脱氧葡萄糖（FDG）-正电子发射断层扫描（PET）/计算机断层扫描（CT）引导下三维近距离放疗（3D-BT）进行首次近距离放疗的宫颈癌患者的治疗效果。我们回顾性分析了87例接受根治性放疗（RT）的宫颈癌患者。22例患者（25.3%）的原发肿瘤大小≤4 cm，45例患者（51.7%）的原发肿瘤大小>4 cm且≤6 cm，20例患者（23.0%）的原发肿瘤大小>6 cm。外照射放疗的中位总剂量为50.4（50.4 - 60.4）Gy。采用铱-192源进行FDG-PET/CT引导下的3D-BT。3D-BT的临床靶区（CTV）包括整个宫颈以及异常摄取FDG且向外扩展1 cm的区域。计划总剂量为24 Gy，每周3次，每次插入剂量为4 Gy，使用施源器和2个卵形体。CTV的平均D95和D90分别为73.4（±5.9）Gy和77.9（±6.9）Gy（等效剂量，α/β = 10）。直肠和膀胱的D2cc分别为每分次374（±97.4）cGy和394（±107.6）cGy。D2cc的等效剂量（α/β = 3）直肠为74.5（±12.4）Gy，膀胱为77.3（±14.6）Gy。中位随访期为40（8 - 61）个月。3年总生存率（OS）、无进展生存率（PFS）和局部控制率（LC）分别为84.7%、72.1%和89.2%。肿瘤≤4 cm的3年LC率为100%，肿瘤>4 cm且≤6 cm的为91.1%，肿瘤>6 cm的为70.5%（P = 0.014）。9例患者出现局部复发。3例患者在CTV外出现局部复发。分别有5例、4例和2例患者发生1级、2级和3级直肠出血。1例患者出现直肠阴道瘘。FDG-PET/CT引导下的3D-BT计划是一种可行的方法，显示出良好的临床效果。
