宫颈癌的图像引导近距离放射治疗：纳瓦拉综合医院的经验
Image-guided brachytherapy in cervical cancer: Experience in the Complejo Hospitalario de Navarra.
作者信息
Villafranca Elena, Navarrete Paola, Sola Amaya, Muruzabal Juan Carlos, Aguirre Sara, Ostiz Santiago, Sanchez Carmen, Guarch Rosa, Lainez Nuria, Barrado Marta
机构信息
Department of Radiation Oncology, Hospital de Navarra, Pamplona, Spain.
Gynaecologic, Hospital de Navarra, Pamplona, Spain.
出版信息
Rep Pract Oncol Radiother. 2018 Nov-Dec;23(6):510-516. doi: 10.1016/j.rpor.2018.09.006. Epub 2018 Oct 19.
PURPOSE
To evaluate dosimetric and clinical findings of MRI-guided HDR brachytherapy (HDR-B) for cervical carcinoma.
MATERIAL AND METHODS
All patients had a CT, MRI and pelvic-paraaortic lymphadenectomy. Treatment: pelvic (+/-)para-aortic3D/IMRT radiotherapy (45 Gy), weekly cisplatin and HDR-B and pelvic node/parametrial boost 60 Gy until interstitial brachytherapy was done. Two implants: 2008-2011: 5 fractions of 6 Gy, 2011: 2016, 4 fractions of 7 Gy. MRI/TAC were done in each implant. The following were defined: GTV, CTH-HR, CTV-IR; OAR: rectum, bladder and sigmoid.
RESULTS
From 2007 to 2016: 57 patients. Patients: T1b2-T2a: 4p, T2b 41p, T3a: 2p; T3B 8p T4a: 2p; N0: 32p, N1 21p, no lymphadenectomy: 4p. Median follow up: 74.6 m (16-122 m), recurrence: 5p local, 6p node, 9p metastasis and 37p without recurrence.Local control 5 years: 90.1%; Ib2-IIB: 94.8%, III-IVa: 72.2%. (:0.01). RDFS 5y was 92.5%; IB2-IIB: 93%, III: 85% (:0.024); for pN0: 100%; pN+ iliac-paraaortic: 71.4% (: 0.007). MFS 5y was 84.1%. Overall survival (OS) at 5y: 66.6% and the cancer specific survival (CEOS) was 74%. Univariate analysis survival: stage Ib2-II 83% vs. III-IVa 41% ( = 0.001); histology: squamous 78%, adenocarcinoma 59.7% (: ns); lymph node: N0 85% vs. PA+P- 72%, and PA+P+ 35% ( = 0.010). In relation with: HR-CTV dose > 85 Gy, CEOS: 82.5% vs. 77%, and volume CTV-HR < 30 cc: 81.8% and >30 cc: 67%; : ns. Acute grade 2-3 toxicity: rectal 15.7%, intestinal 15.7% and vesical 15.5%.
CONCLUSION
Use of interstitial HDR-BQ guided by RM increased CTV-HR dose and local control, like EMBRACE results. Nodal boost improves RDFS and perhaps OS.
目的
评估磁共振成像引导的高剂量率近距离放射治疗（HDR-B）用于宫颈癌的剂量学和临床结果。
材料与方法
所有患者均接受了CT、MRI检查及盆腔-腹主动脉旁淋巴结清扫术。治疗：盆腔（±）腹主动脉旁三维适形调强放疗（45 Gy），每周一次顺铂化疗及HDR-B治疗，盆腔淋巴结/宫旁组织推量至60 Gy，直至完成组织间近距离放射治疗。两次植入治疗：2008 - 2011年：5次，每次6 Gy；2011 - 2016年：4次，每次7 Gy。每次植入治疗均进行了MRI/TAC检查。定义了以下内容：大体肿瘤体积（GTV）、高危临床靶区（CTH-HR）、低危临床靶区（CTV-IR）；危及器官（OAR）：直肠、膀胱和乙状结肠。
结果
2007年至2016年共纳入57例患者。患者情况：T1b2 - T2a期：4例，T2b期：41例，T3a期：2例；T3B期：8例，T4a期：2例；N0期：32例，N1期：21例，未行淋巴结清扫术：4例。中位随访时间：74.6个月（16 - 122个月），复发情况：局部复发5例，淋巴结复发6例，远处转移9例，37例无复发。5年局部控制率：90.1%；Ib2-IIB期：94.8%，III-IVa期：72.2%（P = 0.01）。5年无复发生存率（RDFS）为92.5%；Ib2-IIB期：93%，III期：85%（P = 0.024）；pN0期：100%；pN+髂总-腹主动脉旁淋巴结转移：71.4%（P = 0.007）。5年无远处转移生存率（MFS）为84.1%。5年总生存率（OS）：66.6%，癌症特异性生存率（CEOS）为74%。单因素生存分析：Ib2-II期生存率83% vs. III-IVa期41%（P = 0.001）；组织学类型：鳞状细胞癌78%，腺癌59.7%（P = 无统计学意义）；淋巴结情况：N0期85% vs. 髂总+腹主动脉旁淋巴结转移阴性（PA+P-）72%，髂总+腹主动脉旁淋巴结转移阳性（PA+P+）35%（P = 0.010）。与以下因素相关：高危临床靶区（HR-CTV）剂量>85 Gy，癌症特异性生存率：82.5% vs. 77%，高危临床靶区（CTV-HR）体积<30 cc：81.8%，>30 cc：67%；P = 无统计学意义。急性2 - 3级毒性反应：直肠15.7%，肠道15.7%，膀胱15.5%。
结论
如EMBRACE研究结果所示，使用磁共振成像引导的组织间HDR-BQ可提高高危临床靶区（CTV-HR）剂量及局部控制率。淋巴结推量可改善无复发生存率，可能也会提高总生存率。
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