Aoshika Tomomi, Noda Shin-Ei, Abe Takanori, Kumazaki Yu, Hirai Ryuta, Igari Mitsunobu, Saito Satoshi, Ryuno Yasuhiro, Iino Misaki, Ohta Tomohiro, Kato Shingo
Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan.
Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan.
Brachytherapy. 2022 Nov-Dec;21(6):783-791. doi: 10.1016/j.brachy.2022.06.009. Epub 2022 Aug 1.
To evaluate treatment results and investigate predictors of local control.
In this retrospective study of 236 patients with cervical cancer, we administered CT-based adaptive brachytherapy (BT) in combination with whole- pelvic (WP)- and central shielding (CS)- external beam radiotherapy (EBRT) with or without chemotherapy. The study cohort comprised patients with cervical cancer treated with definitive radiotherapy (RT) or concurrent chemoradiotherapy between June 2013 and March 2019. Local control (LC), overall survival (OS), and late toxicity were evaluated. Predictive factors for LC were analyzed by univariate and multivariate analyses.
Median doses of WP- and CS-EBRT and BT were 30.6 Gy, 19.8 Gy, and 40.3 Gy, respectively. The 3-year LC rates for T1b2, T2a, T2b, T3b, and T4 were 100%, 100%, 97.3%, 86.9%, and 91.7%, respectively (p = 0.346). The 3-year OS for Stages IB, IIB, IIIB, IIIC, and IVA were 100%, 94.8%, 82.5%, 81.7%, and 74.6%, respectively (p = 0.037). Rates of Grade 3-4 gastrointestinal and genitourinary toxicities were 3.8% and 1.7%, respectively. Multivariate analysis showed that T3-4, nonsquamous cell histology, and high-risk clinical target volume (CTV) D90 of BT < 36Gy were independently associated with significantly poorer LC.
The combination of WP- and CS-EBRT and CT-based IGBT with or without concurrent chemotherapy produced favorable LC outcomes with low rates of late toxicities for patients with small or medium-sized tumors. However, LC was less favorable for patients who had large T3 disease, and the use of CS requires caution in these patients.
评估治疗效果并探究局部控制的预测因素。
在这项对236例宫颈癌患者的回顾性研究中，我们采用基于CT的自适应近距离放疗（BT）联合全盆腔（WP）和中央屏蔽（CS）外照射放疗（EBRT），并根据情况联合化疗。研究队列包括2013年6月至2019年3月期间接受根治性放疗（RT）或同步放化疗的宫颈癌患者。评估局部控制（LC）、总生存期（OS）和晚期毒性。通过单因素和多因素分析来分析LC的预测因素。
WP-EBRT、CS-EBRT和BT的中位剂量分别为30.6 Gy、19.8 Gy和40.3 Gy。T1b2、T2a、T2b、T3b和T4期的3年LC率分别为100%、100%、97.3%、86.9%和91.7%（p = 0.346）。IB、IIB、IIIB、IIIC和IVA期的3年OS率分别为100%、94.8%、82.5%、81.7%和74.6%（p = 0.037）。3 - 4级胃肠道和泌尿生殖系统毒性发生率分别为3.8%和1.7%。多因素分析显示，T3 - 4期、非鳞状细胞组织学以及BT的高危临床靶体积（CTV）D90 < 36 Gy与LC显著较差独立相关。
WP-EBRT、CS-EBRT和基于CT的IGBT联合或不联合同步化疗，对于中小型肿瘤患者可产生良好的LC结果且晚期毒性发生率较低。然而，对于患有较大T3期疾病的患者，LC情况较差，并且在这些患者中使用CS时需谨慎。
