Lei Chengzhi, Ma Shaokang, Huang Manni, An Jusheng, Liang Bin, Dai Jianrong, Wu Lingying
Department of Gynecologic Oncology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Department of Radiation Oncology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Front Oncol. 2019 Jun 19;9:520. doi: 10.3389/fonc.2019.00520. eCollection 2019.
The purpose of this study was to evaluate the outcomes and toxicity experienced by cervical cancer patients with positive lymph nodes (LNs) who were treated with intensity-modulated radiation therapy (IMRT) and intracavitary brachytherapy (ICBT) plus concurrent chemotherapy. We retrospectively evaluated 108 cervical cancer patients with computed tomography (CT)-based positive LNs treated with IMRT and ICBT plus concurrent chemotherapy between 2009 and 2011. IMRT plans were designed to deliver 50 Gy to 95% of the planning target volume (PTV; cervical tumor, pelvis, and parametrium), with daily doses of 1.6-1.8 and 60-70 Gy to 95% of the planning gross tumor volume (PGTV)-LN (pelvic or para-aortic LNs), with daily doses of 2.0-2.2 Gy. Overall survival (OS) and progression-free survival (PFS) Kaplan-Meier curves were plotted. Acute and late toxicities were evaluated according to the Radiation Therapy Oncology Group and European Organization for Research and Treatment of Cancer toxicity criteria. Of the 108 cases, 45 were stage IIB and 63 were stage IIIB. The median follow-up was 65 months (range 2-83). Overall, the 5 year cumulative incidences of pelvic failure alone, distant failure alone, and synchronous pelvic and distant failure were 8.3, 12.9, and 8.3%, respectively. The 5 year OS rate was 67.6%, and the 5 year PFS rate was 53.7%. The 5 year cumulative incidence was 9.2% for late gastrointestinal and genitourinary toxicities of Grade ≥3 and 51.8% for acute leukopenia of Grade ≥3. The clinical results suggest that IMRT and ICBT with concurrent chemotherapy is an effective treatment, with acceptable toxicity, for advanced cervical cancer involving positive LNs.
本研究的目的是评估接受调强放射治疗（IMRT）、腔内近距离放疗（ICBT）联合同步化疗的伴有阳性淋巴结（LNs）的宫颈癌患者的治疗效果和毒性反应。我们回顾性评估了2009年至2011年间108例经计算机断层扫描（CT）证实为阳性淋巴结的宫颈癌患者，这些患者接受了IMRT、ICBT联合同步化疗。IMRT计划设计为给予计划靶体积（PTV；宫颈肿瘤、盆腔和宫旁组织）95%的剂量为50 Gy，每日剂量为1.6 - 1.8 Gy；给予计划大体肿瘤体积（PGTV）-LN（盆腔或腹主动脉旁淋巴结）95%的剂量为60 - 70 Gy，每日剂量为2.0 - 2.2 Gy。绘制了总生存期（OS）和无进展生存期（PFS）的Kaplan-Meier曲线。根据放射治疗肿瘤学组和欧洲癌症研究与治疗组织的毒性标准评估急性和晚期毒性反应。108例患者中，45例为IIB期，63例为IIIB期。中位随访时间为65个月（范围2 - 83个月）。总体而言，单纯盆腔失败、单纯远处失败以及同步盆腔和远处失败的5年累积发生率分别为8.3%、12.9%和8.3%。5年总生存率为67.6%，5年无进展生存率为53.7%。≥3级晚期胃肠道和泌尿生殖系统毒性的5年累积发生率为9.2%，≥3级急性白细胞减少的5年累积发生率为51.8%。临床结果表明，IMRT和ICBT联合同步化疗对于伴有阳性淋巴结的晚期宫颈癌是一种有效的治疗方法，且毒性反应可接受。
