Lindegaard Jacob Chr, Assenholt Marianne, Ramlov Anne, Fokdal Lars Ulrik, Alber Markus, Tanderup Kari
a Department of Oncology , Aarhus University Hospital , Aarhus , Denmark.
b Section of Medical Physics, Department of Radiation Oncology , University Clinic Heidelberg and Heidelberg Institute for Radiation Oncology (HIRO) , Heidelberg , Germany.
Acta Oncol. 2017 Nov;56(11):1479-1486. doi: 10.1080/0284186X.2017.1349335. Epub 2017 Aug 29.
More than 50% of patients with locally advanced cervical cancer (LACC) have pathological nodes. Coverage probability (CovP) is a new planning technique allowing for relaxed dose at the boost periphery minimising collateral irradiation. The aim was to report the first early clinical outcome data for CovP based simultaneous integrated boost (SIB) in LACC.
Twenty-three consecutive node positive patients were analysed. FIGO stage IB2/IIB/IIIB/IVA/IVB was 1/14/3/1/4. Treatment was radio(chemo)therapy (RT) delivering 45 Gy/25 fx whole pelvis ± para-aortic region (PAN) using volumetric arc therapy (VMAT) followed by magnetic resonance imaging (MRI) guided brachytherapy. PAN RT (13 pts) was given if >2 nodes or if node(s) were present at the common iliac vessels or PAN. Nodal gross tumour volumes (GTV-N) were contoured on both PET-CT and MRI. Clinical target volume (CTV-N) was formed by fusion of GTV-N and GTV-N. A 5-mm isotropic margin was used for planning target volume (PTV-N). Nodes in the small pelvis were boosted to 55.0 Gy/25 fx. Common iliac and para-aortic nodes received 57.5 Gy/25 fx. Planning aims for CovP were PTV-N D ≥ 90%, CTV-N D ≥ 100% and CTV-N D ≥ 101.5%.
Seventy-four nodes were boosted. A consistent 5.0 ± 0.7 Gy dose reduction from CTV-N D to PTV-N D was obtained. In total, 73/74 nodes were in complete remission at 3 months PET-CT and MRI. Pelvic control was obtained in 21/23 patients. One patient (IB2, clear cell) had salvageable local disease, while another (IIB) failed in a boosted node. Two patients failed in un-irradiated PAN. One patient age 88 (IIIB) did not receive PAN RT, despite a common iliac node. The other (IIB) recurred above L1. Two further patients (IVB) failed systemically.
Since complete remission at 3 months is predictive for favourable long-term nodal control, our study indicates that CovP for SIB is promising.
超过50%的局部晚期宫颈癌（LACC）患者存在病理淋巴结转移。覆盖概率（CovP）是一种新的放疗计划技术，可在瘤床边缘给予较低剂量，从而减少对周围组织的照射。本研究旨在报告基于CovP的同步整合加量（SIB）在LACC治疗中的首批早期临床疗效数据。
对连续23例有淋巴结转移的患者进行分析。国际妇产科联盟（FIGO）分期为IB2/IIB/IIIB/IVA/IVB的患者分别为1/14/3/1/4例。治疗采用容积弧形调强放疗（VMAT）给予全盆腔45 Gy/25次分割，±腹主动脉旁区域（PAN），随后进行磁共振成像（MRI）引导下的近距离放疗。若淋巴结转移数>2个，或髂总血管或PAN区域有淋巴结转移，则给予PAN区域放疗（13例）。在PET-CT和MRI上勾画淋巴结大体肿瘤体积（GTV-N）。临床靶体积（CTV-N）由GTV-N与GTV-N融合形成。计划靶体积（PTV-N）外放5 mm各向同性边界。盆腔内淋巴结加量至55.0 Gy/25次分割。髂总及腹主动脉旁淋巴结给予57.5 Gy/25次分割。CovP的计划目标为PTV-N D≥90%、CTV-N D≥100%和CTV-N D≥101.5%。
共74个淋巴结接受加量放疗。CTV-N D至PTV-N D剂量一致降低5.0±0.7 Gy。3个月时PET-CT和MRI显示，74个淋巴结中有73个完全缓解。23例患者中有21例获得盆腔控制。1例患者（IB2期，透明细胞癌）有可挽救的局部病灶，另1例（IIB期）在加量照射的淋巴结处复发。2例患者在未照射的PAN区域复发。1例88岁患者（IIIB期）尽管有髂总淋巴结转移，但未接受PAN区域放疗。另1例（IIB期）在L1水平以上复发。另有2例患者（IVB期）出现全身转移。
由于3个月时的完全缓解可预测长期淋巴结的良好控制，我们的研究表明CovP用于SIB具有前景。
