Huang Chi-Hsien, Liang Ji-An, Hung Yao-Ching, Yeh Lian-Shung, Chang Wei-Chun, Lin Wu-Chou, Chang Yin-Yi, Chen Shang-Wen
Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan.
Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Clinical Medical Science, School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
Brachytherapy. 2023 Jan-Feb;22(1):72-79. doi: 10.1016/j.brachy.2022.09.004. Epub 2022 Oct 13.
To investigate the outcomes of definitive external-beam radiation therapy (EBRT) plus image-guided brachytherapy (IGBT) in patients with endometrial cancer (EC) unsuitable for surgery.
A total of 50 patients with inoperable EC were included. The patients received EBRT in a median dose of 45 Gy to the pelvis over 5 weeks. Thereafter, the patients received brachytherapy using tandem and ovoid applicators. High-risk clinical target volume (HR-CTV) and gross tumor volume in brachytherapy (GTVp) were defined by the assistance of patients' pre-IGBT magnetic resonance imaging.
The medical records of the 50 patients were analyzed. The main causes of inoperability were anesthesia contraindications, namely medical comorbidities and obesity. The median cumulative D90s (the minimum dose delivered to 90% of the volume) in EQD2 (equivalent dose in 2-Gy fractions) to the HR-CTV and GTVp were 72.9 Gy10 (range, 64.9 to 80.3) and 166.2 Gy10 (range, 123.0 to 189.8), respectively. Over a median follow-up period of 27 months, 8 of the patients died of cancer. The 2-year overall and cancer-specific survival rates were 75% and 83%, respectively. The cumulative incidences of pelvic and distant failure were 4% (n = 2) and 16% (n = 8), respectively. Gastrointestinal complications of grade 2 or above were noted in 2 patients (4%), and a grade 2 genitourinary complication was noted in one.
For patients with inoperable EC, EBRT followed by IGBT is an effective approach for achieving high local control without a high risk of complications.
探讨确定性外照射放疗（EBRT）联合图像引导近距离放疗（IGBT）治疗不适宜手术的子宫内膜癌（EC）患者的疗效。
共纳入50例无法手术的EC患者。患者在5周内接受盆腔中位剂量45 Gy的EBRT。此后，患者使用串联和卵圆形施源器接受近距离放疗。在患者IGBT前磁共振成像的辅助下定义近距离放疗中的高危临床靶区（HR-CTV）和大体肿瘤体积（GTVp）。
分析了50例患者的病历。无法手术的主要原因是麻醉禁忌，即内科合并症和肥胖。HR-CTV和GTVp在EQD2（2 Gy分次等效剂量）中的中位累积D90s（给予90%体积的最小剂量）分别为72.9 Gy10（范围64.9至80.3）和166.2 Gy10（范围123.0至189.8）。中位随访期27个月时，8例患者死于癌症。2年总生存率和癌症特异性生存率分别为75%和83%。盆腔和远处失败的累积发生率分别为4%（n = 2）和16%（n = 8）。2例患者（4%）出现2级或以上胃肠道并发症，1例出现2级泌尿生殖系统并发症。
对于无法手术的EC患者，EBRT序贯IGBT是实现高局部控制且并发症风险不高的有效方法。
