Singh Ankita, Mani Nilesh, Aggarwal Lalit M, Agarwal Sumit, Mourya Ankur, Verma Ashish, Bagchi Antara, Gupta Neha, Choudhary Sunil
Department of Radiotherapy & Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
Department of Radiation Oncology, Mahaveer Cancer Sansthan and Research Centre, Patna, Bihar, India.
Brachytherapy. 2023 Sep-Oct;22(5):616-622. doi: 10.1016/j.brachy.2023.04.010. Epub 2023 Jun 5.
To study the effect of various dose-volume parameters on the severity of vaginal stricture (VS) and the correlation of the latter with the posterior-inferior border of symphysis (PIBS) points in locally advanced cervical cancer patients treated with concurrent chemoradiation and brachytherapy.
A prospective study was done on 45 histologically proven locally advanced cervical cancer patients between January 2020 and March 2021. All of them were treated with concurrent chemoradiation with 6 MV photon linear accelerator to a dose of 45 Gy/25 fractions in 5 weeks. Twenty-three patients were treated with intracavitary brachytherapy with a dose of 7 Gy/fraction/week for three fractions. Twenty-two patients were treated with interstitial brachytherapy, with 6 Gy/fraction for four fractions, each fraction 6 h apart. Grading of VS was done as per Common Terminology Criteria for Adverse Events version 5.
The median followup was 21.5 months. About 37.8% of patients had VS with a median duration of 8.0 months (4.0-12 months). About 22.2% had Grade 1, 6.7% had Grade 2, and 8.9% had Grade 3 toxicity. Doses at PIBS and PIBS-2 points had no correlation with vaginal toxicity, however, the dose at PIBS+2 was significantly associated with VS (p = 0.004). The treated length of the vagina at the time of brachytherapy (p = 0.001), initial tumor volume (p = 0.009), and vaginal involvement after completion of external beam radiotherapy (EBRT) (p = 0.01) were also statistically significant with the development of VS of Grade 2 or more.
Dose at PIBS + 2, treated length of the vagina with brachytherapy, initial tumor volume, and post-EBRT vaginal involvement are strong predictors for the severity of VS.
研究在接受同步放化疗和近距离放疗的局部晚期宫颈癌患者中，各种剂量体积参数对阴道狭窄（VS）严重程度的影响，以及VS与耻骨联合后下缘（PIBS）点的相关性。
对2020年1月至2021年3月期间45例经组织学证实的局部晚期宫颈癌患者进行了一项前瞻性研究。所有患者均使用6MV光子直线加速器进行同步放化疗，剂量为45Gy/25次，共5周。23例患者接受腔内近距离放疗，剂量为7Gy/分次/周，共3次。22例患者接受组织间近距离放疗，剂量为6Gy/分次，共4次，每次间隔6小时。根据《不良事件通用术语标准》第5版对VS进行分级。
中位随访时间为21.5个月。约37.8%的患者发生VS，中位持续时间为8.0个月（4.0 - 12个月）。约22.2%为1级，6.7%为2级，8.9%为3级毒性。PIBS和PIBS - 2点的剂量与阴道毒性无相关性，然而，PIBS + 2点的剂量与VS显著相关（p = 0.004）。近距离放疗时阴道的治疗长度（p = 0.001）、初始肿瘤体积（p = 0.009）以及外照射放疗（EBRT）完成后阴道受累情况（p = 0.01）与2级或更高级别的VS发生也具有统计学意义。
PIBS + 2点的剂量、近距离放疗时阴道的治疗长度、初始肿瘤体积以及EBRT后阴道受累情况是VS严重程度的有力预测因素。
