Chi Yunbo, Pan Ying, Zhang Ning, Han Dongmei, Guo Xin, Mao Zhuang, Cheng Guanghui
Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun, China.
Department of Gynecology, China-Japan Union Hospital of Jilin University, Changchun, China.
Front Oncol. 2022 Mar 17;12:841980. doi: 10.3389/fonc.2022.841980. eCollection 2022.
This study aims to evaluate clinical outcomes of MRI-guided adaptive brachytherapy (MR-IGABT) for each brachytherapy fraction in patients with locally advanced cervical cancer (LACC).
A retrospective analysis was performed on 97 consecutive patients with LACC treated with 44.0-50.4 Gy external beam radiotherapy (EBRT) ± concurrent platinum-containing chemotherapy followed by 4 × 7 Gy MR-IGABT between September 2014 and April 2019. Intracavitary (IC)/interstitial (IS)/hybrid intracavitary and interstitial (IC/IS) brachytherapy was used in MR-IGABT. Brachytherapy planning and dose reporting followed the GEC-ESTRO recommendations. Clinical outcomes including overall survival (OS), cancer-specific survival (CSS), progression-free survival (PFS), local control (LC), and treatment-related toxicity evaluated by the RTOG criteria were analyzed. Kaplan-Meier and univariable and multivariable Cox regression analyses were used to analyze the prognostic factor.
Median follow-up was 21.1 months. Median dose to 90% (D) of the high-risk clinical target volume (HR-CTV) was 91.7 Gy (range 76.7~107.2 Gy). Two-year OS, CSS, PFS, and LC were 83.5%, 84.1%, 71.1%, and 94.8%, respectively. Four patients (4.1%) suffered from grade 3 late gastrointestinal radiation toxicity, and no other grade 3 or greater radiation toxicity occurred. Initial HR-CTV was an independent factor of OS ( = 0.001, HR = 1.018/cm), PFS ( = 0.012, HR = 1.012/cm), and LC ( = 0.011, HR = 1.028/cm). The HR-CTV D ( = 0.044, HR = 0.923/Gy) was an independent factor of PFS. Age was an independent factor of LC ( = 0.010, HR = 1.111/year).
For patients with LACC, MR-IGABT was effective and safe. It showed favorable LC, OS, and minimal toxicity. Moreover, initial HR-CTV, HR-CTV D, and age were significant prognostic factors.
本研究旨在评估磁共振成像引导下的适应性近距离放射治疗（MR-IGABT）对局部晚期宫颈癌（LACC）患者各近距离放射治疗分次的临床疗效。
对2014年9月至2019年4月期间连续97例接受44.0 - 50.4 Gy外照射放疗（EBRT）±同步含铂化疗，随后进行4×7 Gy MR-IGABT治疗的LACC患者进行回顾性分析。MR-IGABT采用腔内（IC）/组织间（IS）/混合腔内和组织间（IC/IS）近距离放射治疗。近距离放射治疗计划和剂量报告遵循GEC-ESTRO建议。分析包括总生存期（OS）、癌症特异性生存期（CSS）、无进展生存期（PFS）、局部控制（LC）以及根据RTOG标准评估的治疗相关毒性等临床结局。采用Kaplan-Meier法以及单变量和多变量Cox回归分析来分析预后因素。
中位随访时间为21.1个月。高危临床靶区（HR-CTV）90%体积的中位剂量（D）为91.7 Gy（范围76.7~107.2 Gy）。两年的OS、CSS、PFS和LC分别为83.5%、84.1%、71.1%和94.8%。4例患者（4.1%）出现3级晚期胃肠道放射性毒性，未发生其他3级或更高级别的放射性毒性。初始HR-CTV是OS（=0.001，HR = 1.018/cm）、PFS（=0.012，HR = 1.012/cm）和LC（=0.011，HR = 1.028/cm）的独立因素。HR-CTV D（=0.044，HR = 0.923/Gy）是PFS的独立因素。年龄是LC的独立因素（=0.010，HR = 1.111/年）。
对于LACC患者而言，MR-IGABT有效且安全。它显示出良好的LC、OS以及最小的毒性。此外，初始HR-CTV、HR-CTV D和年龄是重要的预后因素。
