Ager Bryan J, Francis Samual R, Do Olivia A, Huang Y Jessica, Soisson Andrew P, Dodson Mark K, Werner Theresa L, Sause William T, Grant Jonathan D, Gaffney David K
Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.
Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.
Brachytherapy. 2019 Jul-Aug;18(4):453-461. doi: 10.1016/j.brachy.2019.03.001. Epub 2019 Apr 17.
We sought to retrospectively examine clinical outcomes for three adjuvant vaginal high-dose-rate (HDR) brachytherapy regimens after hysterectomy for early-stage endometrial cancer.
Included were women of all ages from two independent hospital systems diagnosed with Stage I-II endometrial cancer of any grade between 2000 and 2016 who underwent hysterectomy followed by adjuvant vaginal cylinder HDR brachytherapy with either 7.0 Gy × 3 fractions prescribed to 0.5 cm vaginal depth, 6.5 Gy × 3 fractions prescribed to 0.5 cm vaginal depth, or 6.0 Gy × 5 fractions prescribed to the vaginal surface. Outcomes included vaginal recurrence (VR), pelvic recurrence, distant recurrence, locoregional recurrence, recurrence-free survival, and overall survival.
Of the 348 women, 45 (13%) received 7.0 Gy × 3 fractions, 259 (74%) received 6.5 Gy × 3 fractions, and 44 (13%) received 6.0 Gy × 5 fractions. Women receiving 5-fraction brachytherapy were more likely to be younger with a higher performance status. At a median follow-up of 4.5 years, VR rates were 2.2%, 0.8%, and 4.5%, respectively. Multivariate analysis revealed no significant differences in the risks for VR among brachytherapy regimens. Risks for VR, pelvic recurrence, distant recurrence, locoregional recurrence, recurrence-free survival, and overall survival did not differ between propensity score-matched five- and 3-fraction brachytherapy cohorts.
VR rates after hysterectomy and adjuvant vaginal brachytherapy for early-stage endometrial cancer were low and not significantly different by HDR dose fractionation.
我们试图回顾性研究早期子宫内膜癌子宫切除术后三种辅助性阴道高剂量率（HDR）近距离放射治疗方案的临床结局。
纳入2000年至2016年间来自两个独立医院系统的所有年龄段、诊断为任何分级的I-II期子宫内膜癌且接受子宫切除术，随后接受辅助性阴道柱状HDR近距离放射治疗的女性，治疗方案为阴道深度0.5 cm处给予7.0 Gy×3分次、阴道深度0.5 cm处给予6.5 Gy×3分次或阴道表面给予6.0 Gy×5分次。结局包括阴道复发（VR）、盆腔复发、远处复发、局部区域复发、无复发生存率和总生存率。
348名女性中，45名（13%）接受7.0 Gy×3分次，259名（74%）接受6.5 Gy×3分次，44名（13%）接受6.0 Gy×5分次。接受5分次近距离放射治疗的女性更可能年龄较小且身体状况较好。中位随访4.5年时，VR率分别为2.2%、0.8%和4.5%。多因素分析显示近距离放射治疗方案之间VR风险无显著差异。倾向评分匹配的5分次和3分次近距离放射治疗队列之间，VR、盆腔复发、远处复发、局部区域复发、无复发生存率和总生存率的风险无差异。
早期子宫内膜癌子宫切除术后及辅助性阴道近距离放射治疗后的VR率较低，且HDR剂量分割方案之间无显著差异。
