Bronsart E, Petit C, Gouy S, Bockel S, Espenel S, Kumar T, Fumagalli I, Maulard A, Ayachy R El, Genestie C, Leary A, Pautier P, Morice P, Haie-Meder C, Chargari C
Department of Radiation Oncology, Gustave-Roussy, Paris-Saclay University, Villejuif, France.
Department of Gynecologic Surgery, Gustave-Roussy, Villejuif, France.
Cancer Radiother. 2020 Dec;24(8):860-865. doi: 10.1016/j.canrad.2020.10.001. Epub 2020 Oct 29.
Adjuvant external beam radiotherapy (EBRT) was shown to decrease pelvic relapses in patients with an early stage cervical cancer and intermediate-risk histopathological prognostic factors, at the cost of increased bowel morbidity. We examined the feasibility and results of adjuvant brachytherapy alone as an alternative to EBRT in this situation.
Medical records of consecutive patients receiving adjuvant brachytherapy between 1991 and 2018 for an early stage cervical cancer were examined. Patients were included if they presented a pT1a2N0 or pT1b1N0 disease following radical colpohysterectomy. Adjuvant vaginal wall brachytherapy (without EBRT) was indicated because of a tumor size≥2cm and/or presence of lymphovascular space invasion (LVSI). Patients received 60Gy to 5mm of the vaginal wall, through low-dose or pulse-dose rate technique. Patients' outcome was examined for disease control, toxicities and prognostic factors.
A total of 40 patients were included. Eight patients (20%) had LVSI, 26 patients (65%) had a tumor size≥2cm. With median follow-up time of 42.0 months, 90% of patients were in complete remission and four patients (10%) experienced tumor relapse, all in the peritoneal cavity, and associated with synchronous pelvic lymph node failure in 2/4 patients. No vaginal or isolated pelvic nodal failure was reported. At 5 year, overall survival was 83.6% (CI95%: 67.8-100%) and disease-free survival was 85.1% (CI95%: 72.6-99.9%). In univariate analysis, probability of relapse correlated with tumor size≥3cm (P=0.004). No acute or late toxicity grade more than 2 was reported.
Brachytherapy alone was a well-tolerated adjuvant treatment for selected patients with intermediate risk factors. The risk of relapse in patients with tumor size≥3cm was however high, suggesting that EBRT is more appropriate in this situation.
辅助性外照射放疗（EBRT）已被证明可降低早期宫颈癌且具有中度风险组织病理学预后因素患者的盆腔复发率，但代价是肠道发病率增加。我们研究了在这种情况下单独使用辅助性近距离放疗替代EBRT的可行性和结果。
检查了1991年至2018年间连续接受辅助性近距离放疗的早期宫颈癌患者的病历。如果患者在根治性子宫颈子宫切除术后呈现pT1a2N0或pT1b1N0疾病，则纳入研究。由于肿瘤大小≥2cm和/或存在淋巴管间隙浸润（LVSI），因此指示进行辅助性阴道壁近距离放疗（不进行EBRT）。患者通过低剂量或脉冲剂量率技术接受60Gy照射至阴道壁5mm深度。检查患者的疾病控制、毒性和预后因素等结果。
共纳入40例患者。8例患者（20%）有LVSI，26例患者（65%）肿瘤大小≥2cm。中位随访时间为42.0个月，90%的患者完全缓解，4例患者（10%）出现肿瘤复发，均在腹腔内，2/4的患者伴有同步盆腔淋巴结转移。未报告阴道或孤立盆腔淋巴结转移。5年时，总生存率为83.6%（95%CI：67.8 - 100%），无病生存率为85.1%（95%CI：72.6 - 99.9%）。单因素分析中，复发概率与肿瘤大小≥3cm相关（P = 0.004）。未报告超过2级的急性或晚期毒性。
对于选定的具有中度风险因素的患者，单独使用近距离放疗是一种耐受性良好的辅助治疗。然而，肿瘤大小≥3cm的患者复发风险较高，表明在这种情况下EBRT更合适。
