Department of Radiation Oncology, Vydehi institute of medical sciences and research centre, Bengaluru, India.
Department of Radiation Oncology, Vydehi institute of medical sciences and research centre, Bengaluru, India.
Gynecol Oncol. 2021 Oct;163(1):110-116. doi: 10.1016/j.ygyno.2021.07.023. Epub 2021 Jul 23.
This study aimed to prospectively evaluate the impact of dose-escalated irradiation of nodal metastases on clinical outcomes compared to no boost in patients with node-positive, bulky, locally advanced cervical cancer (LACC) undergoing standard chemoradiation and MRI-based brachytherapy.
This comparative study included 161 patients with node-positive LACC treated with definitive chemoradiation and MRI-based brachytherapy. The prospective Boost arm accrued 71 patients to receive nodal boost either sequentially or simultaneously to an equivalent dose of 60 Gy. The control arm comprised 90 patients treated before this protocol period with no additional nodal boost.
Baseline patient and tumor characteristics were similar in both groups. All patients had at least one tumor dimension >5 cm at presentation, and 31% had para-aortic node involvement. With a median follow-up of 36 months (IQR:19-50.5), the overall 3-year Local control rate was 88.8%. The 3-year Regional control (93% vs. 80%, p = 0.035) was statistically better in the Boost arm. No nodal failure was observed in nodes <3 cc and < 2 cm, even in the No-boost arm. There was no significant difference in Disease-free survival (67.6% vs. 58.9%,p = 0.454) and Overall Survival (78.9% vs. 74.4%,p = 0.87) between the two arms. Incidence of acute or late toxicities did not differ significantly with nodal boost or the boost delivery technique.
The addition of external radiation nodal boost to standard treatment of high-volume cervical cancer has improved pelvic control with an acceptable rate of toxicities. However, high systemic failures continue to pose a challenge in improving survival outcomes.
本研究旨在前瞻性评估与标准放化疗联合基于 MRI 的近距离放疗相比，对接受标准放化疗和基于 MRI 的近距离放疗的局部晚期宫颈癌（LACC）伴阳性淋巴结、大肿块患者进行淋巴结转移剂量递增照射对临床结局的影响。
本比较研究纳入了 161 例局部晚期宫颈癌伴阳性淋巴结患者，接受根治性放化疗和基于 MRI 的近距离放疗。前瞻性增敏组纳入 71 例患者，序贯或同时给予 60Gy 等效剂量的淋巴结增敏。对照组包括在该方案实施前接受治疗的 90 例患者，无额外的淋巴结增敏。
两组患者的基线特征和肿瘤特征相似。所有患者在就诊时至少有一个肿瘤维度>5cm，31%有腹主动脉旁淋巴结受累。中位随访 36 个月（IQR：19-50.5），总 3 年局部控制率为 88.8%。增敏组 3 年区域控制率（93%比 80%，p=0.035）更高。在无增敏组，淋巴结<3cc 和<2cm 也未观察到淋巴结失败。两组无病生存率（67.6%比 58.9%，p=0.454）和总生存率（78.9%比 74.4%，p=0.87）无显著差异。急性或迟发性毒性的发生率与淋巴结增敏或增敏方式无显著差异。
将外部放射淋巴结增敏加入高剂量宫颈癌的标准治疗中可提高盆腔控制率，同时毒性反应发生率可接受。然而，高系统失败率仍然是提高生存结果的一个挑战。
