Wang Chenyang, Raince Jagdeep, Swamy Uma, Park Sang-June, Zaide Lalaine, Mesko Shane, Demanes D Jeffrey, Kamrava Mitchell
UCLA Department of Radiation Oncology, Los Angeles, CA.
UCLA Department of Radiation Oncology, Los Angeles, CA.
Brachytherapy. 2018 Mar-Apr;17(2):392-398. doi: 10.1016/j.brachy.2017.10.004. Epub 2017 Nov 8.
Given the limited data using an interstitial approach with 3D-based planning for definitive cervical cancer utilizing the GEC-ESTRO defined high-risk clinical target volume (HR-CTV), we reviewed our institutional experience of cervical cancer patients with HR-CTVs ≥ 30 cc to determine whether our clinical and toxicity outcomes are acceptable.
A retrospective review of 37 cervical cancer patients with high-risk clinical target volumes (HR-CTVs) ≥30 cc treated with interstitial image-guided brachytherapy (IS IGBT) was performed. All patients received external beam radiotherapy to a median dose of 45 Gy, followed by IS IGBT delivered in a single implant to a median dose of 6 Gy × 5 fractions. Median HR-CTV was 59 cc. A median HR-CTV D of 87.44 Gy was achieved. Kaplan-Meier method was used to evaluate local control (LC), distant control, and overall survival (OS), with stratification by overall treatment time (OTT) ≤ 7 or >7 weeks.
Median followup was 17 months. The estimated 2-year LC, distant control, and OS were 77.6% (confidence interval [CI]: 63.8-94.5%), 56.8% (CI: 41.3-78.1%), and 54.4% (CI: 39.4-75%), respectively. The 2-year LC for OTT ≤7 weeks and >7 weeks were 100% and 58.3%, respectively (p = 0.026). The 2-year OS for OTT ≤7 weeks and >7 weeks were 77.8% and 38%, respectively (p = 0.021).
IS IGBT can achieve a high D to the HR-CTV even in the setting of large-volume disease and results in a favorable LC and toxicity profile. OTT > 7 weeks is associated with significant decrease in LC and OS.
Efforts should be made to complete whole treatment within 7 weeks as this is associated with improved clinical outcomes.
鉴于采用基于三维计划的组织间插植方法对宫颈癌进行根治性治疗时，利用GEC-ESTRO定义的高危临床靶区（HR-CTV）的数据有限，我们回顾了我院HR-CTV≥30 cc的宫颈癌患者的治疗经验，以确定我们的临床和毒性结果是否可以接受。
对37例接受组织间图像引导近距离放疗（IS IGBT）的高危临床靶区（HR-CTV）≥30 cc的宫颈癌患者进行回顾性研究。所有患者均接受外照射放疗，中位剂量为45 Gy，随后进行单次插植的IS IGBT，中位剂量为6 Gy×5次分割。中位HR-CTV为59 cc。HR-CTV的中位D值达到87.44 Gy。采用Kaplan-Meier法评估局部控制（LC）、远处控制和总生存（OS），并按总治疗时间（OTT）≤7周或>7周进行分层。
中位随访时间为17个月。估计的2年LC、远处控制和OS分别为77.6%（置信区间[CI]：63.8-94.5%）、56.8%（CI：41.3-78.1%）和54.4%（CI：39.4-75%）。OTT≤7周和>7周的2年LC分别为100%和58.3%（p = 0.026）。OTT≤7周和>7周的2年OS分别为77.8%和38%（p = 0.021）。
即使在大体积疾病的情况下，IS IGBT也能实现HR-CTV的高D值，并带来良好的LC和毒性特征。OTT>7周与LC和OS的显著降低相关。
应努力在7周内完成整个治疗，因为这与改善临床结果相关。
