Brachytherapy Unit, Radiation Oncology, Gustave Roussy, University Paris Saclay, Villejuif, France.
Department of Surgery, Gustave Roussy, University Paris Saclay, Villejuif, France.
Gynecol Oncol. 2020 Jun;157(3):644-648. doi: 10.1016/j.ygyno.2020.03.006. Epub 2020 Mar 13.
Since dose escalation allowed by image-guided adaptive brachytherapy (IGABT) in locally advanced cervical cancer (LACC), local relapses have become a rare event. Only scarce data are available on the outcome of patients experiencing a local relapse after IGABT.
Between 2004 and 2016, all consecutive patients treated at Gustave Roussy Institute for LACC and receiving concomitant chemoradiation and IGABT were analysed. Clinical and treatment-related prognostic factors for survival after local relapse were searched, in order to potentially identify patients requiring salvage treatment.
Two hundred and fifty-nine patients were treated during this period. With a median follow-up of 4.1 years, 10.8% (n = 28) had a local relapse. Among these patients, 53.6% had synchronous lymph nodes or distant metastatic relapse and only 13 patients (5% of all patients) had isolated local relapse. After local relapse, median survival was 47 months and three patients were alive at last follow-up. Only three patients with local relapse could receive salvage surgery (10.7%). Metastases occurrence and pelvic wall involvement were the main contraindications (67.9%) for salvage surgery. Among the three patients treated with surgery, two are still alive at last follow-up without significant complication. Improved survival was observed among the two patients who could have surgery (p = .02). Local progression led to serious symptoms in 75% of patients. Only the time interval between brachytherapy and relapse (<1 year) was prognostic for 2-year overall survival (p = .005).
Salvage surgery is feasible in a very low number of highly selected patients with local relapse following IGABT. Local failure is a major cause of severe local symptoms, confirming that every effort should be done to achieve long-term local control through dose escalation.
由于图像引导自适应近距离放射治疗（IGABT）在局部晚期宫颈癌（LACC）中允许剂量递增，局部复发已成为罕见事件。仅有少量数据可用于描述接受 IGABT 后局部复发的患者的结局。
在 2004 年至 2016 年期间，对在 Gustave Roussy 研究所接受局部晚期宫颈癌同步放化疗和 IGABT 治疗的所有连续患者进行了分析。对局部复发后生存的临床和治疗相关预后因素进行了搜索，以确定可能需要挽救性治疗的患者。
在此期间，有 259 例患者接受了治疗。中位随访时间为 4.1 年，10.8%（n=28）发生了局部复发。在这些患者中，53.6%有同步淋巴结或远处转移复发，仅有 13 例（所有患者的 5%）发生孤立性局部复发。局部复发后，中位生存时间为 47 个月，末次随访时仍有 3 例患者存活。仅有 3 例局部复发患者可以接受挽救性手术（10.7%）。转移发生和骨盆壁侵犯是挽救性手术的主要禁忌证（67.9%）。在接受手术治疗的 3 例患者中，有 2 例在末次随访时仍然存活，没有明显的并发症。能够接受手术治疗的 2 例患者的生存情况有所改善（p=0.02）。局部进展导致 75%的患者出现严重症状。仅在近距离放射治疗和复发之间的时间间隔<1 年是 2 年总生存率的预后因素（p=0.005）。
在接受 IGABT 治疗后发生局部复发的极少数高度选择患者中，挽救性手术是可行的。局部失败是导致严重局部症状的主要原因，这证实了应通过剂量递增努力实现长期局部控制。
