Department of Radiation Oncology, Institute of Oncology Ljubljana, Slovenia; Department of Oncology, Aarhus University Hospital, Denmark.
Department of Oncology, Aarhus University Hospital, Denmark.
Radiother Oncol. 2021 Apr;157:24-31. doi: 10.1016/j.radonc.2021.01.005. Epub 2021 Jan 19.
Multiple treatment options are used in early local-stage cervical cancer, including combinations of surgery with neoadjuvant/adjuvant radiotherapy and chemotherapy. Our aim was to determine the outcome for definitive chemoradiation with image guided brachytherapy (IGBT).
FIGO staging system was used in our study. We included 123 patients with stage IB cervical cancer, treated at 12 centers with external beam radiotherapy (EBRT) ± Chemotherapy and IGBT. Three- and 5-year actuarial local control (LC), pelvic control (PC), overall survival (OS), cancer-specific survival (CSS) and late morbidity (CTCAE v 3.0) were computed.
Median age was 48 (23-82) years. FIGO stage distribution was: IB1 68% and IB2 32%; 41% of the entire cohort had nodal metastases and 73% squamous-cell carcinoma. MRI-based tumor size was >40 mm in 63%. Median EBRT dose was 45 (40-50) Gy; 84% received chemotherapy. At IGBT, mean CTV-HR D90 was 93 ± 17 Gy (EQD2). D2cc for bladder was 76 ± 14 Gy, rectum 66 ± 11 Gy, sigmoid 66 ± 10 Gy, bowel 67 ± 7 Gy (EQD2). At 43-months median follow-up, 9% of patients had systemic, 6% paraaortic, 3% pelvic-nodal and 2% local failure. Five-year LC was 98%, PC 96%, CSS 90%, OS 83%. Intestinal G3--4 morbidity was 8%, urinary 7% and vaginal 0%.
Chemoradiation with IGBT for FIGO stage IB cervical cancer leads to excellent loco-regional control with limited morbidity. In IB node-negative disease, it can be regarded equivalent to surgery in terms of oncologic outcome. In tumors with unfavorable pre-treatment characteristics, chemoradiation is the first choice to avoid combining surgery with adjuvant therapy.
早期局部宫颈癌有多种治疗选择，包括手术联合新辅助/辅助放化疗的联合治疗。我们的目的是确定图像引导近距离放疗（IGBT）的根治性放化疗结果。
本研究采用FIGO 分期系统，纳入 123 例 IB 期宫颈癌患者，在 12 个中心接受外照射放疗（EBRT）±化疗和 IGBT 治疗。计算 3 年和 5 年局部无进展率（LC）、盆腔无进展率（PC）、总生存率（OS）、癌症特异性生存率（CSS）和晚期发病率（CTCAE v3.0）。
中位年龄为 48 岁（23-82 岁）。FIGO 分期分布为：IB1 占 68%，IB2 占 32%；41%的患者有淋巴结转移，73%为鳞癌。MRI 测量的肿瘤大小>40mm 的占 63%。中位 EBRT 剂量为 45Gy（40-50Gy）；84%的患者接受了化疗。在 IGBT 中，CTV-HR D90 的平均剂量为 93Gy±17Gy（EQD2）。膀胱 D2cc 为 76Gy±14Gy，直肠 66Gy±11Gy，乙状结肠 66Gy±10Gy，肠 67Gy±7Gy（EQD2）。中位随访 43 个月时，9%的患者发生远处转移，6%发生主动脉旁淋巴结转移，3%发生盆腔淋巴结转移，2%发生局部复发。5 年 LC 为 98%，PC 为 96%，CSS 为 90%，OS 为 83%。肠道 G3-4 级发病率为 8%，泌尿系统为 7%，阴道为 0%。
FIGO 分期 IB 宫颈癌的 IGBT 放化疗联合治疗可获得良好的局部区域控制，且发病率较低。在淋巴结阴性的 IB 期疾病中，其在肿瘤学结果方面可与手术相媲美。对于具有不良治疗前特征的肿瘤，放化疗是避免联合手术和辅助治疗的首选。
