Department of Radiation Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, India.
Department of Radiation Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, India.
Gynecol Oncol. 2018 Sep;150(3):420-425. doi: 10.1016/j.ygyno.2018.07.012. Epub 2018 Jul 17.
The purpose of this series is to study the effectiveness of MRI based image-guided brachytherapy (IGBT) in Indian patients with cervical cancer who mostly present in later stages with bulky diseases.
151 cervical cancer patients treated at our institution in last four years, with definitive chemoradiation followed by MRI-based brachytherapy were reviewed. With median follow up of 26 months, Kaplan Meier estimates at two years were calculated for local control (LC), pelvic control (PC), disease-free survival (DFS) and overall survival (OS). Also, severe late sequelae were reported.
The patients predominantly presented with locally advanced cervical cancer in FIGO stages IIB (53.6%) and IIIB (23.2%). Tumour dimensions at diagnosis were ≥5 cm in 56.3% and pelvic nodal involvement was found in 38.4% of the patients. 94% of the patients received curative chemoradiation. Mean HRCTV volume at the time of brachytherapy was 42.2 ± 19 cm and mean cumulative dose to HRCTV was 78.9 ± 5.6 Gy. Overall LC, PC, DFS and OS at 2 years were 88.7%, 88.1%, 82.2% and 94% respectively. The predictors for local failure were FIGO stage (p = 0.002) and tumour size at diagnosis (p = 0.009). Late grade 3-4 bladder and bowel toxicities were observed in 3.8% of the patients.
Our review demonstrates that IGBT is an effective strategy to improve locoregional control with limited long-term sequelae in patients with locally advanced extensive cervical cancer in the setting of a developing country.
本系列旨在研究 MRI 引导近距离放疗（IGBT）在印度宫颈癌患者中的有效性，这些患者大多处于晚期，且肿瘤较大。
回顾了过去四年在我院接受根治性放化疗后行 MRI 引导近距离放疗的 151 例宫颈癌患者。中位随访 26 个月后，采用 Kaplan-Meier 估计法计算局部控制率（LC）、盆腔控制率（PC）、无疾病生存率（DFS）和总生存率（OS）。同时报告了严重的晚期并发症。
患者主要表现为 FIGO 分期 IIB 期（53.6%）和 IIIB 期（23.2%）的局部晚期宫颈癌。诊断时肿瘤大小≥5cm 的患者占 56.3%，盆腔淋巴结受累的患者占 38.4%。94%的患者接受了根治性放化疗。近距离放疗时 HRCTV 体积的平均值为 42.2±19cm，HRCTV 累积剂量的平均值为 78.9±5.6Gy。2 年时的总体 LC、PC、DFS 和 OS 分别为 88.7%、88.1%、82.2%和 94%。局部失败的预测因素为 FIGO 分期（p=0.002）和诊断时肿瘤大小（p=0.009）。3.8%的患者出现晚期 3-4 级膀胱和肠道毒性。
我们的回顾性研究表明，IGBT 是一种有效的策略，可以提高局部区域控制率，并在发展中国家的局部晚期广泛宫颈癌患者中产生有限的长期并发症。
