Department of Radiation Oncology, Medical University of Vienna, Austria; Department of Radiation Oncology, Institut Català d'Oncologia, Barcelona, Spain.
Department of Radiation Oncology, Medical University of Vienna, Austria.
Radiother Oncol. 2018 Jun;127(3):449-455. doi: 10.1016/j.radonc.2018.03.026. Epub 2018 Apr 6.
BACKGROUND/PURPOSE: To evaluate the pattern of manifestation and risk factors for lower limb edema (LLE) within the prospective, observational, multi-center EMBRACE study on radiochemotherapy and MRI-guided brachytherapy in locally advanced cervical cancer (LACC).
MATERIAL/METHODS: LLE was prospectively assessed according to the physician-reported CTCAE v.3 and patient-reported EORTC QLQ-CX24 questionnaire at baseline and regular follow-up.
In total, 1176 patients were evaluated with a median follow-up of 27 months. Actuarial analyses revealed 3/5-year estimates of 27%/31% of CTCAE G ≥ 1, 6.1%/6.6% of G ≥ 2 and 0.5%/0.5% for G ≥ 3. Prevalence rates for G ≥ 1 LLE at 3 months, 1, 3 and 5 years after end of treatment were 7%, 12%, 12%, 15% for physician-assessed and 25%, 30%, 30%, 34% for any patient-reported symptoms and showed a steady increase over time. Invasive lymph node staging and obesity at diagnosis are independent significant risk factors for G ≥ 1 LLE, whereas nodal boost has no impact. Extended radiation fields including para-aortic and/or inguinal nodes show a tendency to increase the risk.
Severe LLE after definitive radiochemotherapy in LACC is rare. However, the risk for mild LLE is considerable, and related to patient-, diagnostic- and treatment characteristics. Less invasive diagnostic surgical procedures or non-invasive assessment, less invasive radiotherapy management and active rehabilitation are important pathways for future developments.
背景/目的：评估前瞻性、观察性、多中心 EMBRACE 研究中局部晚期宫颈癌（LACC）放化疗和 MRI 引导近距离放疗中下肢水肿（LLE）的表现模式和危险因素。
材料/方法：根据医师报告的 CTCAE v.3 和患者报告的 EORTC QLQ-CX24 问卷，前瞻性评估 LLE 在基线和定期随访时的情况。
共评估了 1176 例患者，中位随访时间为 27 个月。累计分析显示 CTCAE G≥1 的 3 年和 5 年估计发生率分别为 27%和 31%，G≥2 的发生率分别为 6.1%和 6.6%，G≥3 的发生率分别为 0.5%和 0.5%。治疗结束后 3 个月、1 年、3 年和 5 年时，医师评估的 G≥1 LLE 发生率分别为 7%、12%、12%和 15%，任何患者报告的症状发生率分别为 25%、30%、30%和 34%，且随时间呈稳步上升。侵入性淋巴结分期和诊断时肥胖是 G≥1 LLE 的独立显著危险因素，而淋巴结加量无影响。包括主动脉旁和/或腹股沟淋巴结在内的扩展照射野有增加风险的趋势。
在 LACC 中进行确定性放化疗后，严重的 LLE 罕见。然而，轻度 LLE 的风险相当大，与患者、诊断和治疗特征有关。侵入性较小的诊断性手术或非侵入性评估、侵入性较小的放疗管理和积极的康复是未来发展的重要途径。
