Radiation Oncology Department, University of Brescia, Spedali Civili of Brescia. P.le Spedali Civili, 1, 24123, Brescia, Italy.
Department of Health Physics, Spedali Civili Hospital, Brescia, Lombardia, Italy.
Radiol Med. 2023 Dec;128(12):1542-1552. doi: 10.1007/s11547-023-01705-7. Epub 2023 Aug 28.
Platinum-based chemoradiotherapy and brachytherapy are the standard treatment for locally advanced cervical cancer. Reported long-term outcomes for treated with both IMRT and 3D-Image-guided-adaptive brachytherapy are lacking.
This retrospective study included 165 patients with FIGO Stage IB-IVB cervical cancer, treated with chemoradiotherapy in combination with brachytherapy. External beam radiotherapy was delivered as IMRT/VMAT/TOMO helical or 3DCRT. The intracavitary brachytherapy treatment (ICBT) was performed using two different planning system (with or without optimization).
Among the patient subgroups, comprising those who received IMRT/VMAT/Tomo helical and 3DCRT, as well as those who underwent ICBT planning optimization and those who did not, homogeneity was observed in terms of age, performance status, T stage, N status, TNM stage, and histology. With a median follow-up time of 60.5 months, the 5-year overall survival (OS) in the 3DCRT and IMRT groups was 74.9% and 92.8%, respectively (p = 0.033). The 5-year OS in the ICBT planning optimization group was 93.7%, compared to 75% in the non-optimization group (p = 0.014). Regarding late radiation toxicities, patients in the IMRT group had a lower incidence of chronic rectal toxicity compared to those in the 3DCRT group (6.5% vs. 34.1%, p = 0.001). The group with ICBT planning optimization had a lower incidence of late urinary toxicities (10.4%) compared to the non-optimized ICBT planning group (18.2%, p = 0.012). Similarly, the ICBT planning optimization group had a lower incidence of late rectal toxicity (6.5% with 80% grade 1 and 20% grade 2) compared to the non-optimized ICBT planning group (34.1%, p = 0.001).
In this series, the group of patients receiving optimized ICBT had an advantage in terms of OS and CSS suggesting that the use of new Treatment Planning Systems associated with 3D imaging, improves the long-term survival. Additionally, a significant reduction in late rectal and urinary toxicity has been observed.
铂类化疗联合放疗和近距离放疗是局部晚期宫颈癌的标准治疗方法。但目前缺乏关于调强放疗（IMRT）和 3D 图像引导自适应近距离放疗治疗效果的长期报道。
本回顾性研究纳入了 165 例国际妇产科联盟（FIGO）分期为 IB-IVB 期的宫颈癌患者，这些患者接受了化疗联合放疗和近距离放疗治疗。体外照射放疗采用调强放疗/容积旋转调强放疗/螺旋断层放疗或三维适形放疗。腔内近距离放疗（ICBT）采用两种不同的计划系统（优化或不优化）进行。
在接受调强放疗/容积旋转调强放疗/螺旋断层放疗和三维适形放疗、接受 ICBT 计划优化和未接受 ICBT 计划优化的患者亚组中，年龄、体能状态、T 分期、N 分期、TNM 分期和组织学均具有同质性。中位随访时间为 60.5 个月，三维适形放疗组和调强放疗组的 5 年总生存率（OS）分别为 74.9%和 92.8%（p=0.033）。ICBT 计划优化组的 5 年 OS 为 93.7%，而非优化组为 75%（p=0.014）。关于晚期放射毒性，调强放疗组患者慢性直肠毒性的发生率低于三维适形放疗组（6.5%比 34.1%，p=0.001）。与未优化的 ICBT 计划组相比，ICBT 计划优化组的晚期尿毒性发生率较低（10.4%比 18.2%，p=0.012）。同样，ICBT 计划优化组的晚期直肠毒性发生率较低（6.5%，80%为 1 级和 20%为 2 级），而非优化的 ICBT 计划组为 34.1%（p=0.001）。
在本研究中，接受优化的 ICBT 治疗的患者在 OS 和 CSS 方面具有优势，这表明使用与 3D 成像相关的新治疗计划系统可提高长期生存率。此外，还观察到晚期直肠和尿毒性显著降低。
