Rivera Amanda, Wassel Monica, Brodin Patrik N, Yaparpalvi Ravindra, Velten Christian, Kabarriti Rafi, Garg Madhur, Kalnicki Shalom, Mehta Keyur J
Department of Radiation Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, New York, USA.
Albert Einstein College of Medicine, New York, USA.
J Contemp Brachytherapy. 2021 Apr;13(2):158-166. doi: 10.5114/jcb.2021.105283. Epub 2021 Apr 14.
To report the impact of dose and tumor volume metrics at brachytherapy on outcomes for locally advanced cervical cancer treated with tandem and ovoids intracavitary/interstitial brachytherapy.
FIGO stage IB1-IIIB locally advanced cervical cancer treated with intracavitary/interstitial brachytherapy via a tandem and ovoids hybrid applicator were analyzed. Median high-risk clinical target volume (HR-CTV), rate of tumor volume reduction, EQD D, organ at risk doses, and outcomes were recorded. Univariable and multivariable Cox regression was applied for survival analysis, and logistic regression was used for toxicity analysis.
Seventy-one patients were identified. Median follow-up was 24.9 months, with a 2-year local control of 83.6%, loco-regional control of 72.0%, and overall survival of 88.6%. Median HR-CTV D was 87.4 Gy (IQR = 85.7-90.2). Median HR-CTV D > 90 Gy showed a trend toward improved local control (LC) ( = 0.19). Median HR-CTV was 37.9 cm, and median V was 86.5%. A median HR-CTV of ≥ 40 cm demonstrated worse loco-regional control (LRC) ( = 0.018) and progression-free survival ( = 0.021). Two-year LC and LRC for stage IIB patients with a median HR-CTV < 40 cm were significantly improved as compared to ≥ 40 cm at 100% and 71.8%, respectively ( = 0.019) and 100% and 56.5%, respectively ( = 0.001). However, this trend was not statistically significant for stage IIIB patients. Higher percent per day reduction in HR-CTV during brachytherapy showed improved LRC ( = 0.045). Four percent of patients experienced acute grade 3 genitourinary toxicity, 1% late grade 3 genitourinary and 1% late grade 3 gastrointestinal toxicity.
Tandem and ovoids intracavitary/interstitial brachytherapy provides satisfactory outcomes with modest toxicity. Higher HR-CTV D coverage demonstrated a trend toward improved tumor control. Tumor volume based on median HR-CTV ≥ 40 cm at brachytherapy was prognostic for poor outcomes, even within initial FIGO stage groups warranting caution.
报告近距离放射治疗时剂量和肿瘤体积指标对采用串联和卵圆形施源器进行腔内/组织间近距离放射治疗的局部晚期宫颈癌治疗结果的影响。
分析采用串联和卵圆形混合施源器进行腔内/组织间近距离放射治疗的国际妇产科联盟（FIGO）IB1-IIIB期局部晚期宫颈癌。记录中位高危临床靶体积（HR-CTV）、肿瘤体积缩小率、等效剂量D、危及器官剂量及治疗结果。采用单变量和多变量Cox回归进行生存分析，采用逻辑回归进行毒性分析。
共纳入71例患者。中位随访时间为24.9个月，2年局部控制率为83.6%，局部区域控制率为72.0%，总生存率为88.6%。中位HR-CTV D为87.4 Gy（四分位间距=85.7-90.2）。中位HR-CTV D>90 Gy显示局部控制（LC）有改善趋势（P=0.19）。中位HR-CTV为37.9 cm³，中位V₁₀0为86.5%。中位HR-CTV≥40 cm³显示局部区域控制（LRC）较差（P=0.018）及无进展生存期较差（P=0.021）。与中位HR-CTV≥40 cm³的IIB期患者相比，中位HR-CTV<40 cm³的IIB期患者2年LC和LRC分别显著提高，LC为100%和71.8%（P=0.019），LRC为100%和56.5%（P=0.001）。然而，该趋势在IIIB期患者中无统计学意义。近距离放射治疗期间HR-CTV每日缩小百分比更高显示LRC改善（P=0.045）。4%的患者出现急性3级泌尿生殖系统毒性，1%出现晚期3级泌尿生殖系统毒性，1%出现晚期3级胃肠道毒性。
串联和卵圆形腔内/组织间近距离放射治疗可提供毒性适度且令人满意的治疗结果。更高HR-CTV D覆盖显示肿瘤控制有改善趋势。近距离放射治疗时基于中位HR-CTV≥40 cm³的肿瘤体积对预后不良有预测价值，即使在初始FIGO分期组内也需谨慎。
