Hermesse Johanne, Pleyers Clémence, Gennigens Christine, De Cuypere Marjolein, Lovinfosse Pierre, Seidel Statistician Laurence, Coucke Philippe, Kridelka Frédéric
Department of Radiotherapy Oncology, University Hospital of Liège, Liège, Belgium.
Department of Radiotherapy Oncology, Centre François Baclesse, Esch sur Alzette, Luxembourg.
Strahlenther Onkol. 2023 Feb;199(2):141-148. doi: 10.1007/s00066-022-01982-7. Epub 2022 Aug 9.
This monocentric study aimed to assess the impact of technical advancement in brachytherapy (BT) on local control (LC) and cancer-specific survival (CSS) in locally advanced cervical cancer (LACC).
Since 2010, 211 patients with LACC have been treated with 45/50.4 Gy or 60 Gy radiochemotherapy (RTCT) followed by image-guided adaptive brachytherapy (IGABT) at the authors' institution. In 2013, combined intracavitary and interstitial brachytherapy (BT IC/IS) was implemented and in 2018, pulsed-dose-rate BT (PDR-BT) was replaced by high-dose-rate BT (HDR-BT). LC, CSS, and morbidity according to the RTOG/EORTC scoring system were analyzed. Dose-volume parameters for the high-risk clinical target volume (HRCTV) and organs at risk (OAR) were reported.
While 27 (12.8%) patients died of LACC, complete local remission was achieved in 199 (94.3%). Local relapse decreases with a high D95 in the HRCTV (hazard ratio, HR = 0.85, p = 0.0024). D95 in the HRCTV is lower after 60 Gy even if interstitial BT is used. Mean D95 in the HRCTV is 78.2 Gy, 83.3 Gy, and 83.4 Gy with PDR-BT IC, PDR-BT IC/IS, and HDR-BT IC/IS, respectively, after 45/50.4 Gy. D2 cc of OARs is significantly reduced by using interstitial BT. The mean rectum and sigmoid D2 cc are about 61.5 Gy with PDR-BT IC/IS and significantly decreased with HDR-BT IC/IS. This translates into a low fistula incidence. A very low rate of severe gastrointestinal (3.4%) and genitourinary (2.3%) toxicity was observed with HDR-BT IC/IS.
This large monocentric study provides further evidence that implementation of BT IC/IS has an impact on D95 in the HRCTV, LC, and CSS. There are no differences between HDR and PDR in terms of efficacy, D95 in the HRCTV, and toxicity grade ≥ 3.
本单中心研究旨在评估近距离放射治疗（BT）技术进步对局部晚期宫颈癌（LACC）局部控制（LC）和癌症特异性生存（CSS）的影响。
自2010年以来，作者所在机构的211例LACC患者接受了45/50.4Gy或60Gy的放化疗（RTCT），随后接受图像引导下的自适应近距离放射治疗（IGABT）。2013年实施了腔内和组织间联合近距离放射治疗（BT IC/IS），2018年脉冲剂量率BT（PDR-BT）被高剂量率BT（HDR-BT）取代。分析了根据RTOG/EORTC评分系统的LC、CSS和发病率。报告了高危临床靶区（HRCTV）和危及器官（OAR）的剂量体积参数。
27例（12.8%）患者死于LACC，199例（94.3%）实现了完全局部缓解。HRCTV中高D95时局部复发率降低（风险比，HR = 0.85，p = 0.0024）。即使使用组织间BT，60Gy后HRCTV中的D95也较低。45/50.4Gy后，PDR-BT IC、PDR-BT IC/IS和HDR-BT IC/IS时HRCTV的平均D95分别为78.2Gy、83.3Gy和83.4Gy。使用组织间BT可显著降低OARs的D2cc。PDR-BT IC/IS时直肠和乙状结肠的平均D2cc约为61.5Gy，HDR-BT IC/IS时显著降低。这导致瘘管发生率较低。HDR-BT IC/IS观察到极低的严重胃肠道毒性（3.4%）和泌尿生殖系统毒性（2.3%）发生率。
这项大型单中心研究进一步证明，BT IC/IS的实施对HRCTV中的D95、LC和CSS有影响。HDR和PDR在疗效、HRCTV中的D95和≥3级毒性方面没有差异。
