Kellas-Ślęczka Sylwia, Wojcieszek Piotr, Szlag Marta, Stankiewicz Magdalena, Cholewka Agnieszka, Ślęczka Maciej, Badora-Rybicka Agnieszka, Lelek Piotr, Pruefer Agnieszka, Krzysztofiak Tomasz, Kołosza Zofia, Fijałkowski Marek
Brachytherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Poland.
Radiotherapy Planning Department, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Poland.
J Contemp Brachytherapy. 2022 Feb;14(1):43-51. doi: 10.5114/jcb.2022.112697. Epub 2022 Jan 19.
The aim of the study was to report the outcomes of pre-operative high-dose-rate brachytherapy (pHDR-BT), followed by hysterectomy in patients with early cervical cancer.
From January, 1998 to December, 2003, 113 women with IB1, IB2, and IIA1 cervical cancer (according to International Federation of Gynecology and Obstetrics [FIGO] 2018) were treated with pHDR-BT, and 6 to 8 weeks later followed by radical hysterectomy. Patients found to have positive lymph nodes, residual cervical cancer, involved parametria, or lymphovascular space invasion (LVSI) received post-operative adjuvant therapy.
Post-operatively, 81.4% of patients had a complete response to pHDR-BT in the cervix, and 18.6% had residual cervical cancer. Failures occurred in 11/113 (9.7%) patients (all were stage IIA1), with pelvic recurrences in 5/113 (4.4%) and distant metastasis (DM) in 6/113 (5.3%). The 5- and 10-year disease-free survival (DFS) rates were 100% for IB1 and IB2, and 86.4% and 81.3% for IIA1, respectively. Lymph node involvement and/or residual cervical cancer correlated with worse DFS. Two vesicovaginal fistulas were observed (one in a patient treated only with pHDR-BT and one in a woman, who underwent adjuvant external-beam radiotherapy [EBRT]). Two rectovaginal fistulas and one case of proctitis were observed in patients treated with adjuvant EBRT.
pHDR-BT in early cervical cancer is well-tolerated and effective in sterilizing tumor cells in the cervix. The growing number of publications in this area may help define an optimal therapeutic scheme, but randomized trials are required to determine the best candidates for this treatment modality.In our opinion, cervical cancer patients with FIGO stage IIA1 are not good candidates for pHDR-BT, and could be given this treatment only after rigorous selection, including assessment with state-of-the-art imaging, due to higher probability of treatment failure.
本研究旨在报告早期宫颈癌患者术前高剂量率近距离放疗（pHDR - BT）后行子宫切除术的结果。
1998年1月至2003年12月，113例IB1、IB2和IIA1期宫颈癌患者（根据国际妇产科联盟[FIGO]2018年标准）接受了pHDR - BT治疗，6至8周后行根治性子宫切除术。发现有淋巴结阳性、宫颈癌残留、宫旁组织受累或淋巴血管间隙浸润（LVSI）的患者接受术后辅助治疗。
术后，81.4%的患者宫颈对pHDR - BT完全反应，18.6%有宫颈癌残留。113例患者中有11例（9.7%）出现治疗失败（均为IIA1期），其中5例（4.4%）发生盆腔复发，6例（5.3%）发生远处转移（DM）。IB1和IB2期患者的5年和10年无病生存率（DFS）均为100%，IIA1期分别为86.4%和81.3%。淋巴结受累和/或宫颈癌残留与较差的DFS相关。观察到2例膀胱阴道瘘（1例仅接受pHDR - BT治疗的患者，1例接受辅助外照射放疗[EBRT]的女性）。接受辅助EBRT治疗的患者中观察到2例直肠阴道瘘和1例直肠炎病例。
早期宫颈癌患者的pHDR - BT耐受性良好，对宫颈肿瘤细胞有杀菌作用。该领域越来越多的出版物可能有助于确定最佳治疗方案，但需要进行随机试验以确定这种治疗方式的最佳适用人群。我们认为，FIGO IIA1期宫颈癌患者不是pHDR - BT的理想适用人群，由于治疗失败概率较高，仅在经过严格筛选（包括使用先进成像技术进行评估）后才能给予这种治疗。
