仅在镇静下而非全身或鞍区阻滞麻醉下进行基于 CT 的经阴道混合近距离放疗的临床优势和结果。

Clinical advantage and outcomes of computed tomography-based transvaginal hybrid brachytherapy performed only by sedation without general or saddle block anesthesia.

机构信息

QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan.

出版信息

Cancer Rep (Hoboken). 2022 Nov;5(11):e1607. doi: 10.1002/cnr2.1607. Epub 2022 Mar 1.

DOI:10.1002/cnr2.1607

PMID:35229494

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9675380/

Abstract

BACKGROUND

Three-dimensional image-guided brachytherapy is the standard of care in cervical cancer radiotherapy. In addition, the usefulness of the so-called "hybrid brachytherapy (HBT)" has been reported, which involves the addition of needle applicators to conventional intracavitary brachytherapy for interstitial irradiation.

AIM

To evaluate the clinical outcomes of CT-based HBT consisting of transvaginal insertion of needle applicators (CT-based transvaginal HBT) and only intravenous sedation without general or saddle block anesthesia.

METHODS AND RESULTS

This is a retrospective chart review of patients who received definitive radiotherapy, including CT-based transvaginal HBT, between February 2012 and July 2019. The inclusion criteria were as follows: (i) histologically diagnosed disease, (ii) untreated cervical cancer, (iii) International Federation of Gynecology and Obstetrics (FIGO) stage IB1-IVA disease in the 2008 FIGO staging system, and (iv) patients who underwent CT-based transvaginal HBT at least once in a series of intracavitary brachytherapy. Overall, 54 patients fulfilled the eligibility criteria in the present study. The median follow-up period was 32 (IQR, 19-44) months. No patient complained of symptoms such as persistent bleeding or abdominal pain after the treatment. The 3-year local control (LC), disease-free survival, and overall survival rates for all 54 patients were 86.6%, 60.3%, and 90.7% (95% CI [81.3%-100.0%]), respectively. The 3-year LC rate was 87.7% in patients with FIGO III-IVA and 90.4% in tumor size >6.0 cm. The incidence rate of late adverse events, grade ≥3, in the rectum and bladder was 0% and 1.8%, respectively. In the dose-volume histogram analyses, transvaginal HBT increased the dose of HR-CTV by ~7.5% without significantly increasing the dose of organs at risk.

CONCLUSION

Considering the favorable clinical outcomes, CT-based transvaginal HBT may be a good option for treating cervical cancer.

摘要

背景

三维图像引导近距离放疗是宫颈癌放疗的标准治疗方法。此外，已经报道了所谓的“混合近距离放疗（HBT）”的有用性，它涉及在常规腔内近距离放疗中添加针插器进行间质照射。

目的

评估包括经阴道插入针插器的基于 CT 的 HBT（基于 CT 的经阴道 HBT）和仅静脉镇静而无需全身或鞍区麻醉的 CT 基于 HBT 的临床结果。

方法和结果

这是一项回顾性图表审查，评估了 2012 年 2 月至 2019 年 7 月期间接受根治性放疗（包括 CT 基于经阴道 HBT）的患者。纳入标准如下：（i）组织学诊断疾病，（ii）未经治疗的宫颈癌，（iii）2008 年 FIGO 分期系统中的国际妇产科联合会（FIGO）IB1-IVA 期疾病，以及（iv）在一系列腔内近距离放疗中至少进行过一次 CT 基于经阴道 HBT 的患者。共有 54 名患者符合本研究的入选标准。中位随访时间为 32（IQR，19-44）个月。没有患者在治疗后抱怨持续出血或腹痛等症状。54 名患者的 3 年局部控制（LC）、无病生存率和总生存率分别为 86.6%、60.3%和 90.7%（95%CI[81.3%-100.0%]）。FIGO III-IVA 患者的 3 年 LC 率为 87.7%，肿瘤大小>6.0cm 的患者为 90.4%。直肠和膀胱的晚期不良事件发生率（≥3 级）分别为 0%和 1.8%。在剂量-体积直方图分析中，经阴道 HBT 将 HR-CTV 的剂量增加了约 7.5%，而不会显著增加危险器官的剂量。