Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan.
Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Clinical Medical Science, School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
Taiwan J Obstet Gynecol. 2021 Jan;60(1):111-118. doi: 10.1016/j.tjog.2020.11.017.
To evaluate efficacy of stereotactic body radiotherapy (SBRT) for pelvic boost irradiation in gynecological cancer patients with pelvic recurrence or with intact uterus unsuitable for brachytherapy.
We retrospectively reviewed the medical records of 25 gynecological cancer patients who received SBRT boost for pelvic recurrence (salvage group, n = 14), or for local dose escalation instead of intracavitary brachytherapy due to unfavorable medical condition (definitive group, n = 11). The pelvis was irradiated with a median dose of 54 Gy in six weeks, and then SBRT was prescribed with a range of 10-25Gy in two to five fractions. The cumulative radiobiological equivalent dose in 2-Gy fractions (EQD2) to the tumors ranged from 62.5 to 89.5 Gy (median, 80.7). Overall survival (OS) and in-field relapse-free survival (IFRFS) were calculated using the Kaplan-Meier method.
At the initial assessment, eighteen (72%) patients achieved complete or partial remission, and seven (28%) had stable or progressive disease. With a median follow duration of 12 months, the 1-year IFRFS for salvage and definitive group were 64.5% and 90.0%, whereas the 1-year OS for the two groups were 80.8% and 49.1%, respectively. One patient developed entero-vaginal fistula and one had sigmoid perforation. No patient experienced ≧ grade 3 genitourinary complications.
In gynecological cancer patients with recurrent pelvic tumors or intact uterus unsuitable for brachytherapy, local dose escalation with SBRT resulted in an initial response rate of 72% with acceptable early toxicities. A long-term follow-up is required to assess the impact on local control or survival.
评估立体定向体部放疗（SBRT）在有盆腔复发或因不适宜行近距离放疗而保留子宫的妇科癌症患者中进行盆腔加量放疗的疗效。
我们回顾性分析了 25 例接受 SBRT 盆腔加量放疗的妇科癌症患者的病历资料，其中 14 例患者为挽救性治疗（挽救组），11 例患者因身体状况不适合行腔内近距离放疗而改为局部剂量升级（根治组）。盆腔在 6 周内给予中位剂量 54Gy，然后给予范围为 10-25Gy 的 2-5 次 SBRT。肿瘤的 2-Gy 等效生物剂量（EQD2）累积剂量范围为 62.5-89.5Gy（中位值为 80.7Gy）。采用 Kaplan-Meier 法计算总生存（OS）和肿瘤内无复发生存率（IFRFS）。
在初始评估时，18 例（72%）患者达到完全或部分缓解，7 例（28%）患者疾病稳定或进展。中位随访时间为 12 个月时，挽救组和根治组的 1 年 IFRFS 分别为 64.5%和 90.0%，两组的 1 年 OS 分别为 80.8%和 49.1%。1 例患者发生肠阴道瘘，1 例患者发生乙状结肠穿孔。无患者发生≧3 级泌尿生殖系统并发症。
对于有盆腔复发肿瘤或因不适宜行近距离放疗而保留子宫的妇科癌症患者，SBRT 进行局部剂量升级可获得 72%的初始缓解率，且早期毒性可接受。需要长期随访以评估对局部控制或生存的影响。
