Department of Radiotherapy, Chittaranjan National Cancer Institute, 37 S.P. Mukherjee Road, Kolkata, India.
Department of Radiotherapy, Medical College Hospitals, Kolkata 88, College Street, Kolkata, India.
Br J Radiol. 2019 Dec;92(1104):20180841. doi: 10.1259/bjr.20180841. Epub 2019 Jul 25.
Pelvic side wall dose in locally advanced cervical carcinoma treated with definitive chemoradiation has been debated. The present study investigated relationship of disease recurrence with dose for the pelvic side wall. It also attempted to identify minimal dose that significantly reduced recurrence.
Pelvic side wall recurrence at median 24 months was assessed clinically and radiologically across three groups of patients receiving variable pelvic wall doses using no parametrial boost, external beam or interstitial boost, or dose escalated combined external beam with interstitial boost.
At 24 months, recurrence occurred in 3/155 boost 40/130 no boost patients. ( < 0.0001). Receiver operating characteristic curve analysis demonstrated cut-off pelvic wall dose to be 58.9 Gy ( < 0.0001). Dose escalated combined boost showed no significant benefit compared to single modality parametrial boost ( = 0. 0.553).
Mean pelvic wall dose of at least 58.9 Gy offers clinically significant benefit in pelvic wall control. Doses recommended by guidelines should be adhered to in the patients' best interests.
This preliminary study determined a relationship between recurrence rates and dose to the pelvic side wall and also a cut-off dose that significantly improved pelvic wall control in locally advanced cervical cancer.
局部晚期宫颈癌根治性放化疗后盆壁剂量一直存在争议。本研究探讨了疾病复发与盆壁剂量的关系。还试图确定显著降低复发风险的最小剂量。
通过对接受不同盆壁剂量的三组患者（未行宫旁量、外照射或间质插植量、或外照射联合间质插植剂量递增），中位随访 24 个月，评估临床和影像学的盆壁复发情况。
24 个月时，155 例有/无宫旁量患者中有 3 例/130 例无宫旁量患者出现复发（<0.0001）。受试者工作特征曲线分析显示盆壁剂量的截断值为 58.9Gy（<0.0001）。与单参数宫旁量加量相比，剂量递增联合加量无显著获益（=0.553）。
至少 58.9Gy 的平均盆壁剂量可显著提高盆壁控制的临床获益。为了患者的最佳利益，应遵循指南推荐的剂量。
本初步研究确定了局部晚期宫颈癌复发率与盆壁剂量之间的关系，以及显著提高盆壁控制的截点剂量。
