Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
Medicina (Kaunas). 2023 Jun 17;59(6):1164. doi: 10.3390/medicina59061164.
: Treatment options for most patients with recurrent cervical cancer within the previously irradiated field are limited. This study aimed to investigate the feasibility and safety of re-irradiation using intensity-modulated radiation therapy (IMRT) for patients with cervical cancer who experienced intrapelvic recurrence. : We retrospectively analyzed 22 patients with recurrent cervical cancer who were treated with re-irradiation for intrapelvic recurrence using IMRT between July 2006 and July 2020. The irradiation dose and volume were determined based on the range considered safe for the tumor size, location, and previous irradiation dose. : The median follow-up period was 15 months (range: 3-120) and the overall response rate was 63.6%. Of the symptomatic patients, 90% experienced symptom relief after treatment. The 1- and 2-year local progression-free survival (LPFS) rates were 36.8% and 30.7%, respectively, whereas the 1- and 2-year overall survival (OS) rates were 68.2% and 25.0%, respectively. Multivariate analysis revealed that the interval between irradiations and gross tumor volume (GTV) were significant prognostic factors for LPFS. The response to re-irradiation showed borderline statistical significance for LPFS. The GTV and response to re-irradiation were also independent prognostic factors for OS. Grade 3 late toxicities were observed in 4 (18.2%) of the 22 patients. Recto- or vesico-vaginal fistula occurred in four patients. The irradiation dose was associated with fistula formation with borderline significance. : Re-irradiation using IMRT is a safe and effective treatment strategy for patients with recurrent cervical cancer who previously received RT. Interval between irradiations, tumor size, response to re-irradiation, and radiation dose were the main factors affecting efficacy and safety.
: 对于既往放疗野内复发的大多数宫颈癌患者，治疗选择有限。本研究旨在探讨对既往接受放疗后发生盆腔内复发的宫颈癌患者采用调强放疗（IMRT）进行再放疗的可行性和安全性。 : 我们回顾性分析了 2006 年 7 月至 2020 年 7 月期间 22 例接受 IMRT 再放疗治疗盆腔内复发的宫颈癌患者。照射剂量和体积根据肿瘤大小、位置和既往照射剂量确定。 : 中位随访时间为 15 个月（范围：3-120），总缓解率为 63.6%。在有症状的患者中，90%在治疗后症状缓解。1 年和 2 年局部无进展生存率（LPFS）分别为 36.8%和 30.7%，1 年和 2 年总生存率（OS）分别为 68.2%和 25.0%。多因素分析显示，两次放疗之间的间隔和大体肿瘤体积（GTV）是 LPFS 的显著预后因素。再放疗的反应对 LPFS 有边缘统计学意义。GTV 和再放疗反应也是 OS 的独立预后因素。22 例患者中有 4 例（18.2%）出现 3 级迟发性毒性。4 例发生直肠或阴道膀胱瘘。照射剂量与瘘管形成有显著相关性。 : 对于既往接受过放疗的宫颈癌患者，采用 IMRT 再放疗是一种安全有效的治疗策略。两次放疗之间的间隔、肿瘤大小、对再放疗的反应以及照射剂量是影响疗效和安全性的主要因素。
