Department of Oncotherapy, Clinical Center, University of Pécs, Pécs, Hungary.
Pécs Diagnostic Center, Pécs, Hungary.
Pathol Oncol Res. 2021 Mar 24;27:608446. doi: 10.3389/pore.2021.608446. eCollection 2021.
The aim of this study was to introduce the simultaneous integrated boost (SIB) technique to assess the safety of replacement of the brachytherapy (BT) boost for ineligible patients with cervical cancer receiving radiochemotherapy (RCT). Fourteen patients were enrolled between 2015 and 2018. SIB was delivered using RapidArc technique at doses of 2.4 Gy per fraction during pelvic irradiation with 50.4/1.8 Gy in seven patients (to a total dose of 67.2 Gy) with limited volume disease. In 7 patients with a more advanced disease stage (>5 cm tumor, parametric invasion both sides), parametric boost therapy was added to the pelvic radiotherapy to a total dose of the macroscopic tumor of 79.2 Gy. All patients received simultaneous cisplatin-based chemotherapy for 5 cycles with a dosage of 40 mg/m. We examined acute toxicity (CTCAE v4.1) and quality of life (EORTC QLQ30 and CX24). The tumor regression rate was evaluated with RECIST 1.1 after the first 3- to 4-months follow-up Magnetic Resonance Imaging (MRI) scan. We calculated the percentage of tumor regression rate and the local control during the follow-up period and evaluated the survival data. Our patient data are presented at a median follow-up time of 24.5 months. During the treatment period, no grade 3 to 4 toxicity was observed. During the follow-up period, no late-onset toxicity was observed. The tumor regression rate at the first MRI scan was 95.31% on average. Disease free survival (DFS) during the median follow-up of 24 months was 98.6%. In patients with cervical cancer, the SIB technique is amenable as part of definitive RCT. Dose escalation with the SIB technique can be safely administered to cervical cancer patients during definitive RCT if BT is not feasible. However, further randomized clinical studies are needed to validate the method, so routine use of it cannot be recommended yet.
本研究旨在介绍同步整合推量（SIB）技术，以评估在接受放化疗（RCT）的不适合近距离放射治疗（BT）的宫颈癌患者中替代 BT 推量的安全性。2015 年至 2018 年间，共纳入 14 例患者。SIB 通过 RapidArc 技术在盆腔照射中实施，7 例患者采用 2.4Gy/次的剂量（总量 67.2Gy），这些患者的肿瘤体积有限；7 例疾病进展期患者（肿瘤>5cm，双侧宫旁侵犯）在盆腔放疗中增加参数推量治疗，使宏观肿瘤总量达到 79.2Gy。所有患者均接受同步顺铂为基础的化疗 5 个周期，剂量为 40mg/m。我们检查了急性毒性（CTCAE v4.1）和生活质量（EORTC QLQ30 和 CX24）。在首次 3-4 个月的随访磁共振成像（MRI）后，根据 RECIST 1.1 评估肿瘤消退率。我们计算了肿瘤消退率和随访期间的局部控制率，并评估了生存数据。我们的患者数据在中位随访时间 24.5 个月时呈现。在治疗期间，未观察到 3-4 级毒性。在随访期间，未观察到迟发性毒性。首次 MRI 扫描时，肿瘤消退率平均为 95.31%。中位随访 24 个月时，无病生存率（DFS）为 98.6%。对于宫颈癌患者，SIB 技术可作为确定性 RCT 的一部分。在可行的情况下，SIB 技术可在接受 RCT 的宫颈癌患者中安全地进行剂量递增。然而，需要进一步的随机临床试验来验证该方法，因此目前还不能推荐常规使用。
