Kawashima Atsushi, Isohashi Fumiaki, Mabuchi Seiji, Sawada Kenjiro, Ueda Yutaka, Kobayashi Eiji, Matsumoto Yuri, Otani Keisuke, Tamari Keisuke, Seo Yuji, Suzuki Osamu, Sumida Iori, Tomimatsu Takuji, Kimura Tadashi, Ogawa Kazuhiko
Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamada-oka, Suita, Osaka, Japan.
Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamada-oka, Suita, Osaka, Japan.
J Radiat Res. 2019 Mar 1;60(2):264-269. doi: 10.1093/jrr/rry104.
Outcomes for patients with Stage IB1-IVA cervical cancer treated with computed tomography (CT)-based image-guided brachytherapy (IGBT) were examined in this study. A total of 84 patients were analyzed between March 2012 and June 2015. Whole-pelvic radiotherapy with a central shield was performed for each patient, and the total pelvic sidewall dose was 50 Gy. IGBT was delivered in 2-4 fractions. The initial prescription dose (6.8 Gy) was delivered at Point A, and the dose distribution was modified manually by graphical optimization. The total dose was calculated as the biologically equivalent dose in 2 Gy fractions (EQD2). Concurrent chemotherapy was administered to 64 patients (76%). The median follow-up period was 36 months (range 2-62 months). The 3-year overall survival, local control, and progression-free survival rates were 94%, 89% and 81%, respectively. The mean EQD2 for HR-CTV D90 was 73.4 Gy, and the EQD2 for HR-CTV D90 was not significantly associated with the local control rate. In multivariate analysis, adenocarcinoma (P = 0.03) and tumor size ≥45 mm (P = 0.06) were risk factors for local control. The patients were divided into four groups based on histology (squamous cell carcinoma vs adenocarcinoma) and tumor size (<45 vs ≥45 mm). Those with large adenocarcinomas had significantly worse outcomes. In conclusion, CT-based IGBT achieved favorable local control, but different treatment strategies may be necessary for large adenocarcinomas.
本研究对采用基于计算机断层扫描（CT）的图像引导近距离放疗（IGBT）治疗的IB1-IVA期宫颈癌患者的预后进行了检查。2012年3月至2015年6月期间共分析了84例患者。对每位患者进行了带中央屏蔽的全盆腔放疗，盆腔侧壁总剂量为50 Gy。IGBT分2-4次给予。初始处方剂量（6.8 Gy）在A点给予，剂量分布通过图形优化进行手动调整。总剂量计算为2 Gy分次的生物等效剂量（EQD2）。64例患者（76%）接受了同步化疗。中位随访期为36个月（范围2-62个月）。3年总生存率、局部控制率和无进展生存率分别为94%、89%和81%。HR-CTV D90的平均EQD2为73.4 Gy，HR-CTV D90的EQD2与局部控制率无显著相关性。多因素分析中，腺癌（P = 0.03）和肿瘤大小≥45 mm（P = 0.06）是局部控制的危险因素。根据组织学（鳞状细胞癌与腺癌）和肿瘤大小（<45 vs≥45 mm）将患者分为四组。大腺癌患者的预后明显较差。总之，基于CT的IGBT实现了良好的局部控制，但对于大腺癌可能需要不同的治疗策略。
