Radiation Oncology Dpt. Hospital Clínic Barcelona, C/ Villarroel, 170, 08036 Barcelona, Spain; Fonaments Clínics Dpt. Faculty of Medicine, Universitat de Barcelona, C/ Casanovas 153, 08036 Barcelona, Spain.
Fonaments Clínics Dpt. Faculty of Medicine, Universitat de Barcelona, C/ Casanovas 153, 08036 Barcelona, Spain.
Radiother Oncol. 2023 Dec;189:109909. doi: 10.1016/j.radonc.2023.109909. Epub 2023 Sep 11.
To compare two vaginal brachytherapy (VBT) schedules in postoperative endometrial carcinoma (PEC) patients considering vaginal-cuff relapses (VCR), late toxicities, dosimetry analysis and vaginal dilator use.
110 PEC patients were treated with exclusive high-dose-rate VBT using two schedules. Group-1:44-patients received 6 Gy×3fractions (September-2011-April-2014); Group-2:66-patients were treated with 7.5 Gy×2fractions with a dose limit of equivalent total doses in 2-Gy fr (EQD2) of 68 Gy in the most exposed 2 cm of clinical target volume (CTV) (July-2015-November-2021). The dose was prescribed at 5 mm from the applicator surface. Were evaluated the overall radiation dose delivered to 90% of the CTV (D90), the CTV receiving 100% of the prescription dose (V100) and the EQD2 received in the most exposed 2 cm to dose in CTV. Late toxicity was prospectively assessed using RTOG scores for bladder and rectum and objective LENT-SOMA criteria for late vaginal toxicity (LVT).
Descriptive analysis, Chi-square, Student's t-tests and Kaplan and Meier method.
The median follow-up was 60 months (15.9-60). There were no VCR or late toxicities in bladder or rectum. LVT ≥ G1 appeared in 26/44 (59.1%) in Group-1 and 25/66 (37.9%) in Group-2. The mean EQD2 received by the most exposed 2 cm of CTV was 63.7 Gy ± 10.0 in Group-1 and 60.5 Gy ± 3.8 in Group-2 (p = 0.063). There were no differences in adherence to vaginal dilator use ≥9 months, overall D90 and V100.
Considering the lack of vaginal relapses and similar LVT over time, 7.5 Gy×2fractions seem more efficient in terms of patient comfort, workload, and cost. This is the first study using dosimetry parameters to compare effectivity of schedules. Larger series are needed to confirm the present results.
比较两种阴道近距离放疗（VBT）方案在术后子宫内膜癌（PEC）患者中的疗效，考虑阴道残端复发（VCR）、晚期毒性、剂量学分析和阴道扩张器的使用。
110 例 PEC 患者采用两种方案行单纯高剂量率 VBT 治疗。第 1 组：44 例患者接受 6Gy×3 次分割（2011 年 9 月至 2014 年 4 月）；第 2 组：66 例患者接受 7.5Gy×2 次分割，剂量限制为等剂量曲线 2-Gy 体积（EQD2）在临床靶区（CTV）最暴露的 2cm 处达到 68Gy（2015 年 7 月至 2021 年 11 月）。处方剂量为距施源器表面 5mm。评估了 90%CTV 接受的总辐射剂量（D90）、CTV 接受 100%处方剂量（V100）和最暴露的 2cm 处 CTV 接受的 EQD2。使用 RTOG 膀胱和直肠评分以及 LENT-SOMA 晚期阴道毒性（LVT）标准前瞻性评估晚期毒性。
描述性分析、卡方检验、Student's t 检验和 Kaplan-Meier 方法。
中位随访时间为 60 个月（15.9-60）。第 1 组和第 2 组均无阴道残端复发或晚期膀胱或直肠毒性。第 1 组中有 26/44（59.1%）例出现 LVT≥G1，第 2 组中有 25/66（37.9%）例出现 LVT≥G1。第 1 组和第 2 组中最暴露的 2cm CTV 接受的平均 EQD2 分别为 63.7Gy±10.0 和 60.5Gy±3.8（p=0.063）。第 1 组和第 2 组的阴道扩张器使用≥9 个月的依从性、总体 D90 和 V100 无差异。
考虑到阴道复发率低且晚期 LVT 相似，7.5Gy×2 次分割在患者舒适度、工作量和成本方面似乎更有效。这是第一项使用剂量学参数比较方案疗效的研究。需要更大的系列来证实目前的结果。
