Kokabu Tetsuya, Masui Koji, Tarumi Yosuke, Noguchi Naoki, Aoyama Kohei, Kataoka Hisashi, Matsushima Hiroshi, Yoriki Kaori, Shimizu Daisuke, Yamazaki Hideya, Yamada Kei, Mori Taisuke
Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto 602-8566, Japan.
Department of Radiology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto 602-8566, Japan.
Cancers (Basel). 2022 Feb 28;14(5):1257. doi: 10.3390/cancers14051257.
This study aimed to evaluate the efficacy and safety of computed tomography-magnetic resonance imaging (CT-MRI)-guided multi-catheter interstitial brachytherapy for patients with bulky (≥4 cm) and high-risk, stage IIB-IVB advanced cervical cancer. Eighteen patients who underwent concurrent chemoradiotherapy with multi-catheter interstitial brachytherapy between September 2014 and August 2020 were enrolled. The prescribed dose of external beam radiotherapy was 45-50.4 Gy, and the brachytherapy high-dose-rate aim was 25-30 Gy per 5 fractions. The endpoints were four-year local and pelvic control rates, four-year disease-free and overall survival rates, and the adverse events rate. The median follow-up period was 48.4 months (9.1-87.5 months). Fifteen patients received concurrent cisplatin therapy (40 mg/m, q1week). Four (22.2%), seven (38.9%), and seven (38.9%) patients had stage II, III, and IV cervical cancer, respectively. Pelvic and para-aortic lymph node metastases were observed in 11 (61.1%) and 2 (11.1%) patients, respectively. The median pre-treatment volume was 87.5 cm. The four-year local control, pelvic control, disease-free survival, and overall survival rates were 100%, 100%, 81.6%, and 87.8%, respectively. Three (16.7%) patients experienced grade 3 adverse events, and none experienced grade 4-5 adverse events. CT-MRI-guided multi-catheter interstitial brachytherapy could be a promising treatment strategy for locally advanced cervical cancer.
本研究旨在评估计算机断层扫描-磁共振成像（CT-MRI）引导下多导管组织间近距离放射治疗对体积较大（≥4 cm）且高危的IIB-IVB期晚期宫颈癌患者的疗效和安全性。纳入了2014年9月至2020年8月期间接受多导管组织间近距离放射治疗同步放化疗的18例患者。外照射放疗的处方剂量为45-50.4 Gy，近距离放射治疗高剂量率目标为每5次分割25-30 Gy。观察终点为4年局部和盆腔控制率、4年无病生存率和总生存率以及不良事件发生率。中位随访期为48.4个月（9.1-87.5个月）。15例患者接受了顺铂同步治疗（40 mg/m²，每周1次）。分别有4例（22.2%）、7例（38.9%）和7例（38.9%）患者患有II期、III期和IV期宫颈癌。分别有11例（61.1%）和2例（11.1%）患者观察到盆腔和腹主动脉旁淋巴结转移。治疗前中位体积为87.5 cm³。4年局部控制率、盆腔控制率、无病生存率和总生存率分别为100%、100%、81.6%和87.8%。3例（16.7%）患者发生3级不良事件，无4-5级不良事件发生。CT-MRI引导下多导管组织间近距离放射治疗可能是局部晚期宫颈癌的一种有前景的治疗策略。
