Division of Radiation Oncology, McGill University Health Centre, Montreal, QC H4A 3J1, Canada.
Division of Cancer Epidemiology, Oncology, McGill University, Montreal, QC H4A 3T2, Canada.
Curr Oncol. 2023 May 13;30(5):4966-4978. doi: 10.3390/curroncol30050375.
The treatment paradigm for locally advanced cervical cancer (LACC) has shifted from two-dimensional-brachytherapy (2D-BT) to three-dimensional-image-guided adaptive BT (3D-IGABT). In this retrospective study, we report our experience with the change from 2D-BT to 3D-IGABT.
We reviewed 146 LACC patients (98 3D-IGABT and 48 2D-BT) who received chemoradiation between 2004 and 2019. The multivariable odds ratio (OR) for treatment-related toxicities and hazard ratios (HR) for locoregional control (LRC), distant control (DC), failure-free survival (FFS), cancer-specific survival (CSS) and overall survival (OS) are reported.
The median follow-up was 50.3 months. There was a significant decrease in overall late toxicities in the 3D-IGABT group compared to the 2D-BT group (OR 0.22[0.10-0.52]), late gastrointestinal (OR 0.31[0.10-0.93]), genitourinary (OR 0.31[0.09-1.01]) and vaginal toxicities (0% vs. 29.6%). Grade ≥ 3 toxicity was low in both groups (2D-BT: 8.2% acute, 13.3% late vs. 3D-IGABT: 6.3% acute, 4.4% late, NS). The five-year LRC, DC, FFS, CSS and OS for 3D-IGABT were 92.0%, 63.4%, 61.7%, 75.4% and 73.6%, compared to 87.3%, 71.8%, 63.7%, 76.3% and 70.8% for 2D-BT (NS).
3D-IGABT for the treatment of LACC is associated with a decrease in overall late gastrointestinal, genitourinary and vaginal toxicities. The disease control or survival outcomes were comparable to contemporary 3D-IGABT studies.
局部晚期宫颈癌（LACC）的治疗模式已从二维近距离放疗（2D-BT）转变为三维图像引导自适应 BT（3D-IGABT）。在这项回顾性研究中，我们报告了从 2D-BT 转变为 3D-IGABT 的经验。
我们回顾了 2004 年至 2019 年间接受放化疗的 146 例 LACC 患者（98 例 3D-IGABT 和 48 例 2D-BT）。报告了治疗相关毒性的多变量比值比（OR）和局部区域控制（LRC）、远处控制（DC）、无失败生存（FFS）、癌症特异性生存（CSS）和总生存（OS）的风险比（HR）。
中位随访时间为 50.3 个月。与 2D-BT 组相比，3D-IGABT 组的整体晚期毒性显著降低（OR 0.22[0.10-0.52]），晚期胃肠道（OR 0.31[0.10-0.93]）、泌尿生殖系统（OR 0.31[0.09-1.01]）和阴道毒性（0% vs. 29.6%）。两组的≥3 级毒性均较低（2D-BT：急性 8.2%，晚期 13.3% vs. 3D-IGABT：急性 6.3%，晚期 4.4%，NS）。3D-IGABT 的 5 年 LRC、DC、FFS、CSS 和 OS 分别为 92.0%、63.4%、61.7%、75.4%和 73.6%，而 2D-BT 分别为 87.3%、71.8%、63.7%、76.3%和 70.8%（NS）。
3D-IGABT 治疗 LACC 可降低整体晚期胃肠道、泌尿生殖系统和阴道毒性。疾病控制或生存结果与当代 3D-IGABT 研究相当。
