Uezono Haruka, Tsujino Kayoko, Inoue Yuko, Kajihara Akifumi, Marudai Mitsuru, Bessho Ryosuke, Sekii Shuhei, Kubota Hikaru, Yamaguchi Satoshi, Ota Yosuke
Department of Radiation Oncology, Hyogo Cancer Center, Akashi, Hyogo, Japan.
Department of Radiation Oncology, Hyogo Cancer Center, Akashi, Hyogo, Japan.
Brachytherapy. 2022 Nov-Dec;21(6):814-822. doi: 10.1016/j.brachy.2022.08.012. Epub 2022 Sep 23.
To determine the optimal primary tumor dose for cervical cancer treatment using computed tomography (CT)-based image-guided brachytherapy (IGBT).
We retrospectively reviewed 171 patients with cervical cancer who underwent both external beam radiation therapy (EBRT) and IGBT between May 2015 and December 2019. Majority of EBRT plan included central shielding technique. CT-based IGBT was performed weekly a median of three times. Magnetic resonance imaging preceded the first and third session of IGBT for target delineation.
The median age of the patients was 64 years (range: 30-91 years). The median follow-up time for living patients was 43 months (range: 6-76 months). The 3-year local control rates according to the International Federation of Gynecology and Obstetrics (FIGO, 2008) stages were 89%, 100%, 92%, 89%, 78%, and 100% for stages IB, IIA, IIB, IIIA, IIIB, and IVA, respectively. The median EBRT dose to the central pelvis and parametrium/pelvic wall was 41.4 Gy and 50.4 Gy, respectively. Patients who received a cumulative 2 Gy equivalent dose (EQD2) (α/β = 10 Gy) of high-risk clinical target volume (HR CTV) D90% ≥ 75 Gy achieved a long-term local control rate of 93%, compared with 80% in those who received <75 Gy (p = 0.02).
This is one of the largest CT-based IGBT series examining the treatment of cervical cancer based on the tumor dose-volume relationship. An HR CTV D90% ≥75 Gy was significantly associated with favorable local control in this study.
使用基于计算机断层扫描（CT）的图像引导近距离放疗（IGBT）确定宫颈癌治疗的最佳原发肿瘤剂量。
我们回顾性分析了2015年5月至2019年12月期间接受外照射放疗（EBRT）和IGBT的171例宫颈癌患者。大多数EBRT计划包括中央屏蔽技术。基于CT的IGBT每周进行一次，中位数为三次。在IGBT的第一次和第三次治疗前进行磁共振成像以进行靶区勾画。
患者的中位年龄为64岁（范围：30 - 91岁）。存活患者的中位随访时间为43个月（范围：6 - 76个月）。根据国际妇产科联盟（FIGO，2008）分期，IB、IIA、IIB、IIIA、IIIB和IVA期的3年局部控制率分别为89%、100%、92%、89%、78%和100%。中央盆腔和宫旁组织/盆腔壁的中位EBRT剂量分别为41.4 Gy和50.4 Gy。接受高危临床靶区（HR CTV）D90%累积2 Gy等效剂量（EQD2）（α/β = 10 Gy）≥75 Gy的患者长期局部控制率为93%，而接受<75 Gy的患者为80%（p = 0.02）。
这是基于肿瘤剂量 - 体积关系研究宫颈癌治疗的最大规模的基于CT的IGBT系列研究之一。本研究中，HR CTV D90%≥75 Gy与良好的局部控制显著相关。
