Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA.
Department of Gynecologic Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA.
Gynecol Oncol. 2018 Aug;150(2):293-299. doi: 10.1016/j.ygyno.2018.06.011.
Brachytherapy is integral to vaginal cancer treatment and is typically delivered using an intracavitary single-channel vaginal cylinder (SCVC) or an interstitial brachytherapy (ISBT) applicator. Multi-channel vaginal cylinder (MCVC) applicators allow for improved organ-at-risk (OAR) sparing compared to SCVC while maintaining target coverage. We present clinical outcomes of patients treated with image-based high dose-rate (HDR) brachytherapy using a MCVC.
Sixty patients with vaginal cancer (27% primary vaginal and 73% recurrence from other primaries) were treated with combination external beam radiotherapy (EBRT) and image-based HDR brachytherapy utilizing a MCVC if residual disease thickness was 7 mm or less after EBRT. All pts received 3D image-based BT to a total equivalent dose of 70-80 Gy.
The median high-risk clinical target volume was 24.4 cm (interquartile range [IQR], 14.1), with a median dose to 90% of 77.2 Gy (IQR, 2.8). After a median follow-up of 45 months (range, 11-78), the 4-year local-regional control, distant control, DFS, and OS rates were 92.6%, 76.1%, 64.0%, and 67.2%, respectively. The 4-year LRC rates were similar between the primary vaginal (92%) and recurrent (93%) groups (p = 0.290). Pts with lymph node positive disease had a lower rate of distant control at 4 years (22.7% vs. 89.0%, p < 0.001). There were no Grade 3 or higher acute complications. The 4-year rate of late Grade 3 or higher toxicity was 2.7%.
Clinical outcomes of pts with primary and recurrent vaginal cancer treated definitively in a systematic manner with combination EBRT with image-guided HDR BT utilizing a MCVC applicator demonstrate high rates of local control and low rates of severe morbidity. The MCVC technique allows interstitial implantation to be avoided in select pts with ≤7 mm residual disease thickness following EBRT while maintaining excellent clinical outcomes with extended 4-year follow-up in this rare malignancy.
近距离放射治疗是阴道癌治疗的重要组成部分，通常使用腔内单通道阴道圆柱（SCVC）或间质近距离放射治疗（ISBT）施源器进行。多通道阴道圆柱（MCVC）施源器与 SCVC 相比，可在保持靶区覆盖的同时，更好地保护危及器官（OAR）。我们报告了使用 MCVC 进行基于图像的高剂量率（HDR）近距离放射治疗的患者的临床结果。
60 例阴道癌患者（27%为原发性阴道癌，73%为其他原发性肿瘤复发）在接受外照射放疗（EBRT）联合基于图像的 HDR 近距离放射治疗后，如果 EBRT 后残留病灶厚度≤7mm，则采用 MCVC 进行治疗。所有患者均接受 3D 图像引导 BT，总等效剂量为 70-80Gy。
高危临床靶区的中位体积为 24.4cm（四分位距[IQR]，14.1），90%的中位剂量为 77.2Gy（IQR，2.8）。中位随访 45 个月（范围 11-78 个月）后，4 年局部区域控制、远处控制、DFS 和 OS 率分别为 92.6%、76.1%、64.0%和 67.2%。原发性阴道癌（92%）和复发（93%）组的 4 年 LRC 率相似（p=0.290）。淋巴结阳性疾病患者的远处控制率较低，4 年时为 22.7%（89.0%，p<0.001）。无 3 级或更高的急性并发症。4 年时晚期 3 级或更高毒性的发生率为 2.7%。
采用 EBRT 联合图像引导 HDR BT 联合 MCVC 施源器对原发性和复发性阴道癌患者进行系统治疗，临床结果显示局部控制率高，严重发病率低。在这种罕见的恶性肿瘤中，MCVC 技术允许在 EBRT 后残留病灶厚度≤7mm 的选择患者中避免间质植入，同时在延长的 4 年随访中获得优异的临床结果。
