Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/AKH Wien, Währinger Gürtel 18-20, 1090, Vienna, Austria.
Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria.
Strahlenther Onkol. 2021 Jun;197(6):505-519. doi: 10.1007/s00066-021-01781-6. Epub 2021 Apr 30.
Predicting morbidity for patients with locally advanced cervix cancer after external beam radiotherapy (EBRT) based on dose-volume parameters remains an unresolved issue in definitive radiochemotherapy. The aim of this prospective study was to correlate patient characteristics and dose-volume parameters to various early morbidity endpoints for different EBRT techniques, including volumetric modulated arc therapy (VMAT) and adaptive radiotherapy (ART).
The study population consisted of 48 patients diagnosed with locally advanced cervix cancer, treated with definitive radiochemotherapy including image-guided adaptive brachytherapy (IGABT). Multiple questionnaires (CTCAE 4.03, QLQ-C30 and EORTC QLQ-CX24) were assessed prospectively for patients treated with different EBRT techniques, including online adaptive VMAT. Contouring and treatment planning was based on the EMBRACE protocols. Acute toxicity, classified as general, gastrointestinal (GI) or genitourinary (GU) and their corresponding dose-volume histograms (DVHs) were first correlated by applying least absolute shrinkage and selection operator (LASSO) and subsequently evaluated by multiple logistic binomial regression.
The treated EBRT volumes varied for the different techniques with ~2500 cm for 3D conformal radiotherapy (3D-CRT), ~2000 cm for EMBRACE‑I VMAT, and ~1800 cm for EMBRACE-II VMAT and ART. In general, a worsening of symptoms during the first 5 treatment weeks and recovery afterwards was observed. Dose-volume parameters significantly correlating with stool urgency, rectal and urinary incontinence were as follows: bowel V < 250 cm, rectum V < 80% and bladder V < 80-90%.
This prospective study demonstrated the impact of EBRT treatment techniques in combination with chemotherapy on early morbidity. Dose-volume effects for dysuria, urinary incontinence, stool urgency, diarrhea, rectal bleeding, rectal incontinence and weight loss were found.
在根治性放化疗中，基于剂量-体积参数预测局部晚期宫颈癌患者接受外照射放疗（EBRT）后的发病率仍然是一个尚未解决的问题。本前瞻性研究的目的是将患者特征和剂量-体积参数与不同 EBRT 技术的各种早期发病率终点相关联，包括容积调强弧形治疗（VMAT）和自适应放疗（ART）。
研究人群由 48 名被诊断为局部晚期宫颈癌的患者组成，他们接受了包括图像引导自适应近距离治疗（IGABT）在内的根治性放化疗。对不同 EBRT 技术（包括在线自适应 VMAT）治疗的患者前瞻性评估了多个问卷（CTCAE 4.03、QLQ-C30 和 EORTC QLQ-CX24）。轮廓和治疗计划基于 EMBRACE 方案。急性毒性，分为一般、胃肠道（GI）或泌尿生殖系统（GU），并通过应用最小绝对值收缩和选择算子（LASSO）首次对其相应的剂量-体积直方图（DVH）进行相关性分析，随后通过多项逻辑二项式回归进行评估。
不同技术的治疗 EBRT 体积不同，3D 适形放疗（3D-CRT）约为 2500 cm 3 ，EMBRACE-I VMAT 约为 2000 cm 3 ，EMBRACE-II VMAT 和 ART 约为 1800 cm 3 。总的来说，在最初的 5 周治疗期间观察到症状恶化，随后逐渐恢复。与排便急迫、直肠和尿失禁显著相关的剂量-体积参数如下：肠道 V < 250 cm 3 ，直肠 V < 80%和膀胱 V < 80-90%。
本前瞻性研究表明，EBRT 治疗技术联合化疗对早期发病率有影响。发现了排尿困难、尿失禁、排便急迫、腹泻、直肠出血、直肠失禁和体重减轻的剂量-体积效应。
