Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
Radiation Oncology Key Laboratory of Sichuan Province, Chengdu, China.
BJOG. 2023 Jan;130(2):231-237. doi: 10.1111/1471-0528.17340. Epub 2022 Nov 13.
To investigate the clinical outcomes and toxicity in patients with locally advanced cervical cancer treated with supplementary applicator guided-intensity modulated radiation therapy (IMRT) based on conventional intracavitary brachytherapy (IC/IMRT).
A retrospective cohort study.
Sichuan Cancer Hospital & Institute, Sichuan Cancer Centre, China.
Large high-risk clinical target volume (HR-CTV) volume (>40 ml) at the time of brachytherapy cervical cancer patients were recruited.
This study is a retrospective analysis of 76 patients with locally advanced cervical cancer (FIGO IIB-IVA) treated with concurrent chemoradiotherapy followed by IC/IMRT between June 2010 and October 2016. External radiotherapy (45 Gy in 25 fractions) was adminstered with cisplatin chemotherapy treatment before IC/IMRT. The IMRT plan was optimised using the ICBT plan base dose plan by an inverse dose optimisation tool which allows the use of DVH constraints on the total dose of ICBT. A seven-field gantry angle IMRT plan was devised to avoid hotspots when optimising the boost plan. The prescription dose for HR-CTV and IR-CTV were 6 and 5 Gy per fraction for five fractions, respectively.
Mean HR-CTV was 65.8 ± 23.6 ml at the time of brachytherapy. D90 for HR-CTV and IR-CTV were 88.7 ± 3.6 Gy and 78.1 ± 2.5 Gy. D2cc for bladder, rectum, sigmoid and small intestine were 71.8 ± 3.8, 64.6 ± 4.9, 63.9 ± 5.3 and 56.7 ± 8.7 Gy, respectively. Median follow-up was 85 months (47.9-124.2 months). Five-year local recurrence-free survival rate, metastasis recurrence-free survival rate, disease-free survival rate and cancer-special survival rate were 87.6, 82.4, 70.9 and 76.3%, respectively. The grade 1 + 2 gastrointestinal and urinary late toxicities were 15.8 and 21.1%, and grade 3 late toxicities were 3.9 and 5.2%, respectively. Neither acute nor late grade 4 gastrointestinal or urinary toxicities were seen.
The combination of ICBT with an applicator-guided supplementary IMRT boost achieved excellent local control and overall survival with low toxicity for bulky residual cervical tumour.
研究补充施源器引导调强放疗（IMRT）在基于常规腔内近距离放疗（IC/IMRT）治疗局部晚期宫颈癌患者中的临床结果和毒性。
回顾性队列研究。
中国四川肿瘤医院&研究所，四川癌症中心。
招募了在近距离放疗时具有大高危临床靶区（HR-CTV）体积（>40ml）的宫颈癌患者。
本研究是对 2010 年 6 月至 2016 年 10 月期间接受同步放化疗后行 IC/IMRT 的 76 例局部晚期宫颈癌（FIGO IIB-IVA）患者的回顾性分析。在 IC/IMRT 之前，给予外照射（25 次分割，45Gy）和顺铂化疗。通过逆剂量优化工具，在 ICBT 基础剂量计划上优化 IMRT 计划，该工具允许对 ICBT 的总剂量使用 DVH 限制。为了在优化增敏计划时避免热点，设计了一个七野机架角度 IMRT 计划。HR-CTV 和 IR-CTV 的处方剂量分别为五分次，每次 6Gy 和 5Gy。
在近距离放疗时，HR-CTV 的平均体积为 65.8±23.6ml。HR-CTV 和 IR-CTV 的 D90 分别为 88.7±3.6Gy 和 78.1±2.5Gy。膀胱、直肠、乙状结肠和小肠的 D2cc 分别为 71.8±3.8Gy、64.6±4.9Gy、63.9±5.3Gy 和 56.7±8.7Gy。中位随访时间为 85 个月（47.9-124.2 个月）。5 年局部无复发生存率、远处转移无复发生存率、无病生存率和癌症特异性生存率分别为 87.6%、82.4%、70.9%和 76.3%。1+2 级胃肠道和泌尿系统晚期毒性分别为 15.8%和 21.1%，3 级晚期毒性分别为 3.9%和 5.2%。未观察到急性或迟发性 4 级胃肠道或泌尿系统毒性。
腔内近距离放疗联合施源器引导补充 IMRT 增敏治疗大体积残留宫颈癌，可获得良好的局部控制和总体生存率，且毒性低。
