Kissel Manon, Silva Marlon, Lequesne Justine, Grellard Jean-Michel, Loiseau Cédric, Barraux Victor, Lerouge Delphine, Lecornu Marie, Lesaunier François, Haie-Meder Christine, Chargari Cyrus, Thariat Juliette
Radiotherapy Department, Centre de lutte contre le cancer François Baclesse/ARCHADE, Caen, France.
Radiotherapy Department, Centre de lutte contre le cancer François Baclesse/ARCHADE, Caen, France.
Brachytherapy. 2019 Nov-Dec;18(6):753-762. doi: 10.1016/j.brachy.2019.08.004. Epub 2019 Sep 5.
Correct tandem implantation for cervix cancer intracavitary brachytherapy may be challenging. We investigated whether suboptimal implantation can be related to patient and disease characteristics and may result in subsequent underutilization of brachytherapy in cervical cancer.
Consecutive cervix cancer patients referred for intracavitary brachytherapy after external beam radiation therapy performed in several general hospitals from 2013 to 2017 were included.
In 172 patients having 301 procedures, 95 implantations were suboptimal (15% inadequate tandem insertions, 10% subserosal insertion, and 6% uterine perforation on postimplant CT scan). Risk factors were age, myometrium invasion, and uterine retroversion. Median followup was 21 months. Three-year local control and survival rates were 72% and 85%, respectively. Forty-seven patients (27%) failed to receive brachytherapy. Failure to perform brachytherapy was associated with poorer local control (OR = 0.34 [0.17-0.67], p = 0.001). By contrast, suboptimal implantation did not increase local failure or toxicity rates in patients undergoing brachytherapy. No peritoneal carcinomatosis occurred after uterine perforation in our cohort.
Suboptimal implantation was frequent. In the absence of image guidance during implantation, conversion to other treatment modalities (including external beam radiation therapy) due to insertion difficulties resulted in worse local control. With optimization, however, suboptimal brachytherapy implantation did not result in suboptimal dose coverage or poorer local control. Failure to perform a brachytherapy boost correlates with increased local failure risk in patients with cervix cancer, whereas tandem malposition does not. Real-time intraoperative ultrasound guidance may be useful to reduce uterine perforation rates and thus increase brachytherapy use.
宫颈癌腔内近距离放疗中正确的串联插植可能具有挑战性。我们研究了次优插植是否与患者和疾病特征相关，以及是否会导致随后宫颈癌近距离放疗利用不足。
纳入2013年至2017年在几家综合医院接受体外放射治疗后转诊接受腔内近距离放疗的连续宫颈癌患者。
在172例患者的301次操作中，95次插植为次优（植入后CT扫描显示15%串联插入不足，10%浆膜下插入，6%子宫穿孔）。危险因素为年龄、肌层浸润和子宫后倾。中位随访时间为21个月。三年局部控制率和生存率分别为72%和85%。47例患者（27%）未接受近距离放疗。未进行近距离放疗与较差的局部控制相关（OR = 0.34 [0.17 - 0.67]，p = 0.001）。相比之下，次优插植并未增加接受近距离放疗患者的局部失败率或毒性发生率。在我们的队列中，子宫穿孔后未发生腹膜种植转移。
次优插植很常见。在插植过程中缺乏图像引导时，由于插入困难而转换为其他治疗方式（包括体外放射治疗）会导致局部控制更差。然而，通过优化，次优的近距离放疗插植并未导致剂量覆盖不足或局部控制更差。未进行近距离放疗强化与宫颈癌患者局部失败风险增加相关，而串联位置不当则不然。实时术中超声引导可能有助于降低子宫穿孔率，从而增加近距离放疗的应用。
