Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Radiat Oncol. 2022 May 12;17(1):91. doi: 10.1186/s13014-022-02063-w.
To analyze the prognostic factors associated with stage IB-IVA cervical cancer in patients who underwent concurrent chemoradiation therapy (CCRT) and to compare the clinical toxicities and dosimetric parameters of organs at risk between the different radiotherapy techniques.
This retrospective study enrolled 93 patients with stage IB-IVA cervical cancer who underwent definitive CCRT between April 2009 and December 2017. Nine patients (9.7%) received 3DCRT, 43 patients (46.2%) underwent VMAT, and 41 patients (44.1%) received tomotherapy, and all of them followed by brachytherapy using a 2D planning technique. The treatment outcomes and related prognostic factors were analyzed. We also compared the clinical toxicities and dosimetric parameters between the different techniques used for the last 30 patients.
With a median follow-up of 52.0 months, the 5-year overall survival (OS), progression-free survival (PFS), locoregional recurrence-free survival (LRRFS), and distant metastases-free survival (DMFS) were analyzed. In a Cox proportional hazards regression model, pretreatment SCC Ag > 10 ng/mL was a significant prognostic factor for PFS (hazard ratio [HR] 2.20; 95% confidence interval [CI] 1.03-4.70; P = 0.041), LRRFS (HR, 3.48; 95% CI 1.07-11.26; P = 0.038), and DMFS (HR 2.80; 95% CI 1.02-7.67; P = 0.045). Increasing the rectal volume receiving a radiation dose exceeding 30 Gy (V of rectum; odds ratio [OR] 1.15; 95% CI 1.10-1.30; P = 0.03) was associated with a higher possibility of ≥ Grade 2 acute radiation therapy (RT)-related diarrhea. The median rectal V values were 56.4%, 97.5%, and 86.5% for tomotherapy, 3-dimensional conformal radiation therapy (3DCRT), and volumetric modulated arc therapy (VMAT), respectively (P < 0.001). In addition, the chance of experiencing ≥ Grade 2 acute diarrhea were 10.0%, 66.7%, and 54.5% for tomotherapy, 3DCRT, and VMAT, respectively (P = 0.029).
Patients with pretreatment SCC Ag ≤ 10 ng/mL have better PFS, LRRFS, and DMFS than those with pretreatment SCC Ag > 10 ng/mL. The rectal V is a significant predictor of severe acute diarrhea. Tomotherapy significantly decreased the rectal V, reducing the severity of acute RT-related diarrhea during external beam RT. Trial registration This study was approved by the institutional review board at Kaohsiung Medical University Hospital. The registration number is KMUHIRB-E(I)-20190054 and retrospectively registered on 2019/3.
分析接受同期放化疗（CCRT）的 IB-IVA 期宫颈癌患者的预后因素，并比较不同放疗技术的危及器官临床毒性和剂量学参数。
本回顾性研究纳入了 2009 年 4 月至 2017 年 12 月期间接受根治性 CCRT 的 93 例 IB-IVA 期宫颈癌患者。9 例（9.7%）患者接受 3DCRT，43 例（46.2%）接受 VMAT，41 例（44.1%）接受调强放疗，所有患者均采用二维计划技术进行后装放疗。分析治疗结果和相关的预后因素。我们还比较了最后 30 例患者中不同技术的临床毒性和剂量学参数。
中位随访 52.0 个月，分析了 5 年总生存率（OS）、无进展生存率（PFS）、局部区域无复发生存率（LRRFS）和远处转移无复发生存率（DMFS）。在 Cox 比例风险回归模型中，治疗前 SCC Ag >10ng/mL 是 PFS（风险比[HR]2.20；95%置信区间[CI]1.03-4.70；P=0.041）、LRRFS（HR，3.48；95%CI 1.07-11.26；P=0.038）和 DMFS（HR 2.80；95%CI 1.02-7.67；P=0.045）的显著预后因素。直肠接受超过 30Gy 剂量的直肠体积（V of rectum）增加（比值比[OR]1.15；95%CI 1.10-1.30；P=0.03）与≥2 级急性放疗（RT）相关腹泻的可能性更高有关。调强放疗、三维适形放疗（3DCRT）和容积旋转调强放疗（VMAT）的直肠 V 值中位数分别为 56.4%、97.5%和 86.5%（P<0.001）。此外，调强放疗、3DCRT 和 VMAT 发生≥2 级急性腹泻的概率分别为 10.0%、66.7%和 54.5%（P=0.029）。
治疗前 SCC Ag ≤10ng/mL 的患者比治疗前 SCC Ag >10ng/mL 的患者有更好的 PFS、LRRFS 和 DMFS。直肠 V 是严重急性腹泻的重要预测因子。调强放疗显著降低了直肠 V，降低了外照射放疗期间急性 RT 相关腹泻的严重程度。
本研究得到高雄医学大学附设中和纪念医院机构审查委员会的批准。注册号为 KMUHIRB-E(I)-20190054，并于 2019 年 3 月 20 日进行了回顾性注册。
