Vavassori Andrea, Riva Giulia, Spoto Ruggero, Lazzari Roberta, Fodor Cristiana, Dicuonzo Samantha, Francia Claudia Maria, Augugliaro Matteo, Facondo Giuseppe, Cambria Raffaella, Comi Stefania, Cattani Federica, Botta Francesca, Bagnardi Vincenzo, Rizzo Stefania, Colombo Nicoletta, Orecchia Roberto, Jereczek-Fossa Barbara Alicja
Department of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy.
Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.
J Contemp Brachytherapy. 2019 Dec;11(6):516-526. doi: 10.5114/jcb.2019.90478. Epub 2019 Dec 8.
To analyse the survival outcomes and toxicity profile of patients treated with pulsed-dose-rate (PDR) brachytherapy (BT) after intensity-modulated radiation therapy (IMRT) for uterine cervical cancer in a single institution.
Between March 2011 and December 2014, 50 patients with histologically proven stages IB1-IVB cervical cancer were treated with IMRT followed by PDR-BT boost. Radiation treatment consisted of IMRT to pelvic with or without paraaortic lymph nodes to a total dose of 45-50.4 Gy. Weekly concomitant chemotherapy was administered to 45 patients. PDR-BT boost was delivered with a median dose of 30 Gy to the high-risk clinical target volume (HR-CTV) after a median time of 14 days since IMRT. Acute and late toxicity were evaluated by Radiation Therapy Oncology Group (RTOG) - European Organization for Research and Treatment of Cancer (EORTC) scoring criteria and Subjective Objective Management Analytic-Late Effects of Normal Tissues (SOMA-LENT) criteria.
Two patients had tumour persistence at 6 months after the end of BT. After a median follow-up of 33 months, 6 distant metastases with or without regional relapse were observed. The 1- and 5-year progression-free survival was 83% (95% CI: 69-91%) and 76% (95% CI: 61-86%), whereas the 3- and 5-year overall survival was 91% (95% CI: 78-97%) and 76% (95% CI: 56-88%), respectively. Urinary and rectal toxicity higher than grade 2 was observed in 6.3% and 17% of patients, respectively. Five patients (10.6%) had grade 4 gastrointestinal toxicity requiring colostomy.
Our study confirms that the combination of IMRT and PDR-BT can be considered an effective treatment for cervical cancer, ensuring high local control, despite the high percentage of locally advanced disease.
分析在单一机构中，接受调强放射治疗（IMRT）后采用脉冲剂量率（PDR）近距离放射治疗（BT）的子宫颈癌患者的生存结局和毒性特征。
2011年3月至2014年12月期间，50例经组织学证实为IB1-IVB期宫颈癌的患者接受了IMRT，随后进行PDR-BT增敏治疗。放射治疗包括对盆腔进行IMRT，照射或不照射腹主动脉旁淋巴结，总剂量为45-50.4 Gy。45例患者接受了每周同步化疗。PDR-BT增敏治疗在IMRT后中位时间14天对高危临床靶区（HR-CTV）给予中位剂量30 Gy。急性和晚期毒性根据放射治疗肿瘤学组（RTOG）-欧洲癌症研究与治疗组织（EORTC）评分标准以及主观客观管理分析-正常组织晚期效应（SOMA-LENT）标准进行评估。
2例患者在BT结束后6个月出现肿瘤持续存在。中位随访33个月后，观察到6例有或无区域复发的远处转移。1年和5年无进展生存率分别为83%（95%CI：69-91%）和76%（95%CI：61-86%），而3年和5年总生存率分别为91%（95%CI：78-97%）和76%（95%CI：56-88%）。分别有6.3%和17%的患者出现高于2级的泌尿和直肠毒性。5例患者（10.6%）出现4级胃肠道毒性，需要进行结肠造口术。
我们的研究证实，IMRT和PDR-BT联合可被认为是宫颈癌的一种有效治疗方法，尽管局部晚期疾病比例较高，但能确保较高的局部控制率。
