Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Gynecol Oncol. 2018 Dec;151(3):444-448. doi: 10.1016/j.ygyno.2018.09.024. Epub 2018 Sep 25.
Image guidance should be used for patients with cervical cancer treated with definitive intensity-modulated radiation therapy (IMRT). In this study, we provided a pattern of image guidance and verified it in a large population.
We retrospectively analyzed patients with stages IB1-IVA cervical cancer treated with IMRT combined with high-dose brachytherapy and concurrent chemotherapy in our institute from January 2005 to December 2015. A dose of 50.4 Gy in 28 fractions was prescribed to the planning target volume with fixed-field IMRT, volumetric modulated arc therapy, or helical tomotherapy. Daily megavoltage computed tomography (CT) or weekly cone-beam CT (CBCT)/CT-on-rail were used for image guidance. Considering tumor regression during treatment, a second CT simulation and IMRT planning after 20 fractions of IMRT was performed.
A total of 1433 patients were included in this study. Four hundred thirteen patients (28.8%) had regional lymph node metastases. A total of 1261 patients (88.0%) received concurrent chemotherapy. The median follow-up was 32.2 months (range, 1.9-124.9 months). The 3-year overall survival (OS), disease-free survival (DFS), and local control (LC) rates were 83.0%, 75.0%, and 87.4%, respectively. The 3-year DFS rates for patients with stages IB1, IB2, IIA, IIB, IIIA, IIIB, and IVA disease were 90.2%, 87.6%, 84.0%, 76.7%, 61.6%, 59.8%, and 25.9%. The incidence rates of grade 3 or greater chronic gastrointestinal and genitourinary toxicities were 2.3% and 1.3%.
This pattern of image guidance was rational for patients with cervical cancer treated with IMRT. The survival rates were high, and the toxicities were acceptable.
对于接受根治性调强放疗（IMRT）的宫颈癌患者，应采用图像引导。在本研究中，我们提供了一种图像引导模式，并在大量人群中进行了验证。
我们回顾性分析了 2005 年 1 月至 2015 年 12 月在我院接受 IMRT 联合高剂量近距离放疗和同期化疗的 Ib 期至 IVA 期宫颈癌患者。计划靶区（PTV）接受 50.4Gy/28 次分割，采用固定野调强放疗、容积调强弧形治疗或螺旋断层放疗。每日行兆伏级 CT（MVCT）或每周锥形束 CT（CBCT）/轨道 CT 进行图像引导。考虑到治疗期间肿瘤消退，在 IMRT 完成 20 次分割后进行第二次 CT 模拟和 IMRT 计划。
共有 1433 例患者纳入本研究。413 例（28.8%）患者有区域淋巴结转移。1261 例（88.0%）患者接受同期化疗。中位随访时间为 32.2 个月（范围 1.9-124.9 个月）。3 年总生存率（OS）、无病生存率（DFS）和局部控制率（LC）分别为 83.0%、75.0%和 87.4%。Ib1、Ib2、IIA、IIB、IIIA、IIIB 和 IVA 期患者的 3 年 DFS 率分别为 90.2%、87.6%、84.0%、76.7%、61.6%、59.8%和 25.9%。3 级或以上慢性胃肠道和泌尿生殖系统毒性发生率为 2.3%和 1.3%。
对于接受 IMRT 的宫颈癌患者，这种图像引导模式是合理的。生存率高，毒性反应可接受。
