Kamran Sophia C, Manuel Matthias M, Cho Linda P, Damato Antonio L, Schmidt Ehud J, Tempany Clare, Cormack Robert A, Viswanathan Akila N
Harvard Radiation Oncology Program, Boston, MA, United States.
Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA, United States; Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, United States; Bronx-Lebanon Hospital Center, Bronx, NY, United States.
Gynecol Oncol. 2017 May;145(2):284-290. doi: 10.1016/j.ygyno.2017.03.004. Epub 2017 Mar 18.
The purpose was to compare local control (LC), overall survival (OS) and dose to the organs at risk (OAR) in women with locally advanced cervical cancer treated with MR-guided versus CT-guided interstitial brachytherapy (BT).
56 patients (29 MR, 27 CT) were treated with high-dose-rate (HDR) interstitial BT between 2005-2015. The MR patients had been prospectively enrolled on a Phase II clinical trial. Data were analyzed using Kaplan-Meier (K-M) and Cox proportional hazards statistical modeling in JMP® & R®.
Median follow-up time was 19.7months (MR group) and 18.4months (CT group). There were no statistically significant differences in patient age at diagnosis, histology, percent with tumor size >4cm, grade, FIGO stage or lymph node involvement between the groups. Patients in the MR group had more lymphovascular involvement compared to patients in the CT group (p<0.01). When evaluating plans generated, there were no statistically significant differences in median cumulative dose to the high-risk clinical target volume or the OAR. 2-year K-M LC rates for MR-based and CT-based treatments were 96% and 87%, respectively (log-rank p=0.65). At 2years, OS was significantly better in the MR-guided cohort (84% vs. 56%, p=0.036). On multivariate analysis, squamous histology was associated with longer OS (HR 0.23, 95% CI 0.07-0.72) in a model with MR BT (HR 0.35, 95% CI 0.08-1.18). There was no difference in toxicities between CT and MR BT.
In this population of locally advanced cervical-cancer patients, MR-guided HDR BT resulted in estimated 96% 2-year local control and excellent survival and toxicity rates.
比较磁共振引导与计算机断层扫描引导的组织间近距离放射治疗（BT）用于局部晚期宫颈癌女性患者时的局部控制（LC）、总生存期（OS）以及危及器官（OAR）所接受的剂量。
2005年至2015年间，56例患者（29例接受磁共振引导，27例接受计算机断层扫描引导）接受了高剂量率（HDR）组织间BT治疗。接受磁共振引导治疗的患者前瞻性纳入了一项II期临床试验。在JMP®和R®软件中使用Kaplan-Meier（K-M）法和Cox比例风险统计模型对数据进行分析。
中位随访时间为19.7个月（磁共振引导组）和18.4个月（计算机断层扫描引导组）。两组患者在诊断时的年龄、组织学类型、肿瘤大小>4cm的患者百分比、分级、国际妇产科联盟（FIGO）分期或淋巴结受累情况方面无统计学显著差异。与计算机断层扫描引导组患者相比，磁共振引导组患者的脉管浸润更多（p<0.01）。评估生成的计划时，高危临床靶体积或OAR的中位累积剂量无统计学显著差异。基于磁共振引导和基于计算机断层扫描引导治疗的2年K-M LC率分别为96%和87%（对数秩检验p=0.65）。2年时，磁共振引导队列的OS显著更好（84%对56%，p=0.036）。在多变量分析中，在包含磁共振引导BT的模型中，鳞状组织学与更长的OS相关（风险比0.23，95%置信区间0.07-0.72）。计算机断层扫描引导BT和磁共振引导BT之间的毒性无差异。
在这组局部晚期宫颈癌患者中，磁共振引导的HDR BT导致估计2年局部控制率为96%，且生存率和毒性率良好。
