Department of Oncology, Clínica Universitaria de Navarra, University of Navarra, Avda Pío XII s/n, Pamplona, Navarre, Spain.
Department of Gynecology and Obstaetrics, Clínica Universitaria de Navarra, University of Navarra, Avda Pío XII s/n, Pamplona, Navarre, Spain.
Clin Transl Oncol. 2021 Sep;23(9):1934-1941. doi: 10.1007/s12094-021-02601-0. Epub 2021 Apr 9.
Pelvic recurrences from previously irradiated gynecological cancer lack solid evidence for recommendation on salvage.
A total of 58 patients were included in this clinical analysis. Salvage surgery was performed for locoregional relapse within previously irradiated pelvic area after initial surgery and adjuvant radiotherapy or radical external beam radiotherapy. The primary tumor diagnosis included cervical cancer (n = 47, 81%), uterine cancer (n = 4, 7%), and other types (n = 7, 12%). Thirty-three patients received adjuvant IOERT (1984-2000) at a median dose of 15 Gy (range 10-20 Gy) and 25 patients received adjuvant PHDRB (2001-2016) at a median dose of 32 Gy (range 24-40 Gy) in 6, 8, or 10 b.i.d. fractions.
The median follow-up was 5.6 years (range 0.5-14.2 years). Twenty-nine (50.0%) patients had positive surgical margins. Grade ≥ 3 toxic events were recorded in 34 (58.6%) patients. The local control rate at 2 years was 51% and remained stable up to 14 years. Disease-free survival rates at 2, 5, and 10 years were 17.2, 15.5, and 15.5%, respectively. Overall survival rates at 2, 5, and 10 years were 58.1, 17.8, and 17.8%, respectively.
IOERT and PHDRB account for an effective salvage in oligorecurrent gynecological tumors. Patients with previous pelvic radiation suitable for salvage surgery and at risk of inadequate margins could benefit from adjuvant reirradiation in form of IOERT or PHDRB. However, the rate of severe grade ≥ 3 toxicity associated with the entire treatment program is relevant and needs to be closely counterbalanced against the expected therapeutic gain.
先前接受放射治疗的妇科癌症患者的盆腔复发缺乏挽救治疗的推荐证据。
共纳入 58 例患者进行临床分析。对初始手术后和辅助放疗或根治性外照射放疗后先前照射的盆腔区域局部复发进行挽救性手术。原发肿瘤诊断包括宫颈癌（n=47，81%）、子宫内膜癌（n=4，7%）和其他类型（n=7，12%）。33 例患者接受辅助术中近距离放疗（IOERT）（1984-2000 年），中位剂量 15 Gy（范围 10-20 Gy），25 例患者接受辅助后装近距离放疗（PHDRB）（2001-2016 年），中位剂量 32 Gy（范围 24-40 Gy），6、8 或 10 次/日分次。
中位随访时间为 5.6 年（范围 0.5-14.2 年）。29 例（50.0%）患者手术切缘阳性。34 例（58.6%）患者记录到≥3 级毒性事件。2 年局部控制率为 51%，14 年内保持稳定。2、5 和 10 年无疾病生存率分别为 17.2%、15.5%和 15.5%。2、5 和 10 年总生存率分别为 58.1%、17.8%和 17.8%。
IOERT 和 PHDRB 是妇科肿瘤寡复发的有效挽救治疗方法。先前接受过盆腔放疗、适合挽救性手术且有切缘不足风险的患者可从 IOERT 或 PHDRB 形式的辅助再放疗中获益。然而，与整个治疗方案相关的严重程度≥3 级毒性的发生率是相关的，需要与预期的治疗获益密切平衡。
