Faivre Jean-Christophe, Jung Paul, Salleron Julia, Baumard Florian, Courrech Florent, Marchal Frédéric, Peiffert Didier, Renard Sophie, Charra-Brunaud Claire
Department of Radiation Oncology, Institut de Cancérologie de Lorraine, Vandœuvre-lès-Nancy, France.
Department of Biostatistics and Data Management, Institut de Cancérologie de Lorraine, Vandœuvre-lès-Nancy, France.
J Contemp Brachytherapy. 2023 Feb;15(1):27-36. doi: 10.5114/jcb.2023.124936. Epub 2023 Feb 9.
We assessed prognostic factors of local control and progression-free survival (PFS) of patients treated for AJCC stages T1 and T2 cervical cancer using utero-vaginal brachytherapy after chemoradiotherapy.
This retrospective single-institution analysis included patients who underwent brachytherapy after radiochemotherapy between 2005 and 2015 at the Institut de Cancérologie de Lorraine. Adjuvant hysterectomy was optional. A multivariate analysis of prognostic factors was carried out.
Of 218 patients, 81 (37.2%) were AJCC stage T1, and 137 (62.8%) were AJCC stage T2. 167 (76.6%) patients had squamous cell carcinoma, 97 (44.5%) patients had pelvic nodal disease, and 30 (13.8%) patients had para-aortic nodal disease. One hundred eighty-four patients (84.4%) underwent concomitant chemotherapy, while adjuvant surgery was performed in 91 patients (41.9%) and 42 (46.2%) patients had pathological complete response. Median follow-up was 4.2 years, and local control was reported in 87.8% (95% CI: 83.0-91.8) and 87.2% (95% CI: 82.3-91.3) of patients at 2 and 5 years, respectively. In multivariate analysis, T stage (hazard ratio [HR] = 3.65, 95% CI: 1.27-10.46, = 0.016) was associated with local control. PFS was reported in 67.6% (95% CI: 60.9-73.4) and 57.4% (95% CI: 49.3-64.2) of patients at 2 and 5 years, respectively. In multivariate analysis, para-aortic nodal disease (HR = 2.03, 95% CI: 1.16-3.54, = 0.012), pathological complete response (HR = 0.33, 95% CI: 0.15-0.73, = 0.006), and intermediate-risk clinical tumor volume of > 60 cc (HR = 1.90, 95% CI: 1.22-2.98, = 0.005) were associated with PFS.
Lower dose brachytherapy may benefit AJCC stages T1 and T2 tumors, whereas higher doses are required for larger tumors and para-aortic nodal disease involvement, respectively. Pathological complete response should be associated with better local control and not surgery.
我们评估了接受放化疗后采用子宫 - 阴道近距离放疗的AJCC T1和T2期宫颈癌患者的局部控制和无进展生存期（PFS）的预后因素。
这项回顾性单机构分析纳入了2005年至2015年在洛林癌症研究所接受放化疗后进行近距离放疗的患者。辅助性子宫切除术为可选项。对预后因素进行了多变量分析。
218例患者中，81例（37.2%）为AJCC T1期，137例（62.8%）为AJCC T2期。167例（76.6%）患者为鳞状细胞癌，97例（44.5%）患者有盆腔淋巴结转移，30例（13.8%）患者有腹主动脉旁淋巴结转移。184例（84.4%）患者接受了同步化疗，91例（41.9%）患者进行了辅助手术，42例（46.2%）患者达到病理完全缓解。中位随访时间为4.2年，2年和5年时分别有87.8%（95%CI：83.0 - 91.8）和87.2%（95%CI：82.3 - 91.3）的患者实现局部控制。在多变量分析中，T分期（风险比[HR]=3.65，95%CI：1.27 - 10.46，P = 0.016）与局部控制相关。2年和5年时分别有67.6%（95%CI：60.9 - 73.4）和57.4%（95%CI：49.3 - 64.2）的患者有PFS。在多变量分析中，腹主动脉旁淋巴结转移（HR = 2.03，95%CI：1.16 - 3.54，P = 0.012）、病理完全缓解（HR = 0.33，95%CI：0.15 - 0.73，P = 0.006）以及临床肿瘤体积>60 cc的中危情况（HR = 1.90，95%CI：1.22 - 2.98，P = 0.005）与PFS相关。
较低剂量的近距离放疗可能对AJCC T1和T2期肿瘤有益，而较大肿瘤和腹主动脉旁淋巴结转移受累分别需要更高剂量。病理完全缓解应与更好的局部控制相关，而非手术。
