Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, Taiwan; Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan.
Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan.
Gynecol Oncol. 2017 Jul;146(1):20-26. doi: 10.1016/j.ygyno.2017.04.016. Epub 2017 Apr 27.
To evaluate the effects of prophylactic sub-renal vein radiotherapy (SRVRT) using intensity-modulated radiotherapy (IMRT) for cervical cancer.
A total of 206 patients with FIGO stage IB2-IVA cervical cancer and negative para-aortic lymph nodes (PALNs) who underwent pelvic IMRT (PRT) or SRVRT between 2004 and 2013 at our institution were reviewed. SRVRT cranially extended the PRT field for PALNs up to the left renal vein level. The prescribed dose was consistent 50.4Gy in 28 fractions.
Overall, 110 and 96 patients underwent PRT and SRVRT, respectively. The SRVRT group had more advanced disease based on FIGO stage and positive pelvic lymph nodes (PLNs). The median follow-up time was 60months (range, 7-143). For the total study population, the 5-year PALN recurrence-free survival (PARFS) and overall survival (OS) for PRT vs. SRVRT were 87.6% vs. 97.9% (p=0.03) and 74.5% vs. 87.8% (p=0.04), respectively. In patients with FIGO III-IVA or positive PLNs, the 5-year PARFS and OS for PRT vs. SRVRT were 80.1% vs. 96.4% (p=0.02) and 58.1% vs. 83.5% (p=0.012), respectively. However, there were no significant differences in these outcomes for patients with FIGO IB-IIB and negative PLNs. In a multivariate analysis, only SRVRT was associated with better PARFS (HR, 0.21; 95% CI, 0.06-0.78; p=0.02). The SRVRT did not significantly increase severe late toxicities.
Prophylactic SRVRT using IMRT reduced PALN recurrence with tolerable toxicities, supporting the application of risk-based radiation fields for cervical cancer.
评估采用调强放疗（IMRT）对宫颈癌预防性肾下静脉放疗（SRVRT）的效果。
回顾性分析 2004 年至 2013 年期间在我院接受盆腔调强放疗（PRT）或 SRVRT 的 206 例FIGO 分期 IB2-IVA 宫颈癌且腹主动脉旁淋巴结（PALNs）阴性的患者。SRVRT 将 PRT 野颅侧扩展至左肾静脉水平以包括 PALNs。处方剂量为 50.4Gy，共 28 次。
共有 110 例患者接受 PRT，96 例患者接受 SRVRT。根据FIGO 分期和盆腔淋巴结阳性（PLNs），SRVRT 组疾病更晚期。中位随访时间为 60 个月（7-143 个月）。对于总研究人群，PRT 与 SRVRT 的 5 年 PALN 无复发生存率（PARFS）和总生存率（OS）分别为 87.6%和 97.9%（p=0.03）和 74.5%和 87.8%（p=0.04）。在 FIGO III-IVA 期或 PLNs 阳性的患者中，PRT 与 SRVRT 的 5 年 PARFS 和 OS 分别为 80.1%和 96.4%（p=0.02）和 58.1%和 83.5%（p=0.012）。然而，在 FIGO IB-IIB 期和 PLNs 阴性的患者中，这些结局没有显著差异。多因素分析显示，只有 SRVRT 与更好的 PARFS 相关（HR，0.21；95%CI，0.06-0.78；p=0.02）。SRVRT 并未显著增加严重的晚期毒性。
采用 IMRT 的预防性 SRVRT 降低了 PALN 复发率，且毒性可耐受，支持基于风险的宫颈癌放射野应用。
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