Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA.
Department of Gynecologic Oncology, UPMC Magee-Womens Hospital, Pittsburgh, PA.
Brachytherapy. 2021 Jan-Feb;20(1):104-111. doi: 10.1016/j.brachy.2020.08.006. Epub 2020 Sep 17.
The Vienna and Venezia (Elekta) are hybrid intracavitary/interstitial brachytherapy (BT) applicators for cervical cancers unsuitable for intracavitary BT alone to improve target coverage or reduce critical organ dose. There is limited outcome data with the use of these applicators outside published experience of the EMBRACE group. We report feasibility and early outcomes with the use of these hybrid applicators at our institution.
Hybrid applicators were used to treat 61 patients with cervical cancer from November 2011 to December 2019. Indications for hybrid applicator use were involvement of the vagina in 10 patients (16%), residual central or parametrial disease in 46 patients (75%), and a narrow introitus in 5 patients (9%). Toxicities were graded using the CTCAE v4.0. Outcomes were assessed with the Kaplan-Meier method.
Median follow-up was 16 months (IQR 9-32 mos). Median HRCTV volume was 31.6 cm (IQR 25-48 cm). Median HRCTV D90 was 86.1 Gy (IQR 84.3-88.0 Gy). In 54 patients with follow-up PET/CT at 3 months, complete initial imaging response locally was seen in 46 patients.Estimated 12-month Kaplan-Meier overall survival, locoregional control, distant control, and recurrence-free survival estimates were 86.9%, 80.6%, 73.8%, and 65.9%, respectively. The 12-month incidence of Grade 3+ GI/GU chronic toxicities was 5.7%, consisting of vesicovaginal fistula, rectovaginal fistula, and ureterovesical fistula.
Our single-institution data support the use of the hybrid applicators, as an alternative to traditional BT applicators when clinically warranted. Use of hybrid applicators is feasible with adequate coverage of disease in the vagina and parametrium.
维也纳和威尼斯（Elekta）是一种混合腔内/间质近距离放射治疗（BT）适形器，适用于不适合单独腔内 BT 的宫颈癌患者，以提高靶区覆盖率或降低关键器官剂量。在 EMBRACE 组发表的经验之外，使用这些适形器的结果数据有限。我们报告了我们机构使用这些混合适形器的可行性和早期结果。
2011 年 11 月至 2019 年 12 月，我们使用混合适形器治疗了 61 例宫颈癌患者。使用混合适形器的适应证为 10 例（16%）患者阴道受累、46 例（75%）患者中央或旁中央残留疾病和 5 例（9%）患者阴道入口狭窄。毒性采用 CTCAE v4.0 分级。采用 Kaplan-Meier 法评估结果。
中位随访时间为 16 个月（IQR 9-32 个月）。中位 HRCTV 体积为 31.6cm（IQR 25-48cm）。中位 HRCTV D90 为 86.1Gy（IQR 84.3-88.0Gy）。在 54 例有 3 个月 PET/CT 随访的患者中，46 例患者局部初始影像学反应完全。估计 12 个月的 Kaplan-Meier 总生存率、局部区域控制率、远处控制率和无复发生存率分别为 86.9%、80.6%、73.8%和 65.9%。12 个月时，3 级及以上胃肠道/泌尿系统慢性毒性的发生率为 5.7%，包括膀胱阴道瘘、直肠阴道瘘和输尿管膀胱瘘。
我们的单机构数据支持在临床上需要时，将混合适形器作为传统 BT 适形器的替代物。混合适形器的使用是可行的，可充分覆盖阴道和宫旁的病变。
