Song Jiheon, Alyamani Najlaa, Bhattacharya Gaurav, Le Tien, E Choan, Samant Rajiv
Division of Radiation Oncology, The Ottawa Hospital, Ottawa Ontario, Canada.
Division of Gynecologic Oncology, The Ottawa Hospital, Ottawa Ontario, Canada.
Adv Radiat Oncol. 2020 Feb 28;5(3):419-425. doi: 10.1016/j.adro.2020.02.003. eCollection 2020 May-Jun.
Radical concurrent chemoradiotherapy with combined external beam radiotherapy (EBRT) and brachytherapy is used to treat locally advanced cervical cancer. Our institution has transitioned to high-dose-rate (HDR) intracavitary brachytherapy (ICBT) from low-dose-rate (LDR) brachytherapy in 2008, and a review was conducted on the effect of this change on patient outcomes.
A single-arm retrospective chart review was performed on locally advanced (Fédération Internationale de Gynécologie et d'Obstétrique stage IB-IVA) patients with cervical cancer treated with combined external beam radiation therapy and HDR-ICBT with curative intent between 2008 and 2014. Clinical outcomes were evaluated, and multivariate analysis was performed to identify prognostic factors.
Of the 76 patients selected, median age was 47.9 years and median follow-up was 5.2 years. Thirteen patients (17.1%) developed locoregional recurrence and 23 patients (30.3%) patients developed distant recurrence. Five-year progression-free survival and overall survival were 63.7% and 69.3%, respectively. A significant survival difference was found between stages ( < .001). Multivariate analysis found nodal involvement was strongly associated with poorer survival ( = .007).
Our experience with the transition to HDR-ICBT as part of concurrent chemoradiotherapy in treatment of locally advanced cervical cancer resulted in acceptable long-term outcomes and toxicity to that of LDR brachytherapy. Potential further improvement of treatment outcomes for patients may be possible with image guided brachytherapy and the addition of effective systemic therapy.
外照射放疗（EBRT）联合近距离放疗的根治性同步放化疗用于治疗局部晚期宫颈癌。我院于2008年从低剂量率（LDR）近距离放疗过渡到高剂量率（HDR）腔内近距离放疗（ICBT），并对这一改变对患者预后的影响进行了回顾。
对2008年至2014年间接受外照射放疗联合HDR-ICBT且有治愈意向的局部晚期（国际妇产科联盟分期IB-IVA）宫颈癌患者进行单臂回顾性病历审查。评估临床结果，并进行多因素分析以确定预后因素。
在入选的76例患者中，中位年龄为47.9岁，中位随访时间为5.2年。13例患者（17.1%）发生局部区域复发，23例患者（30.3%）发生远处复发。5年无进展生存率和总生存率分别为63.7%和69.3%。各分期之间存在显著的生存差异（P<0.001）。多因素分析发现淋巴结受累与较差的生存率密切相关（P = 0.007）。
我们将HDR-ICBT作为同步放化疗一部分用于治疗局部晚期宫颈癌的经验，带来了可接受的长期结果，且毒性与LDR近距离放疗相当。图像引导近距离放疗和添加有效的全身治疗可能会进一步改善患者的治疗结果。
