Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Department of Radiation Oncology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
Cancer Med. 2024 Sep;13(18):e70269. doi: 10.1002/cam4.70269.
Image guidance is recommended for patients undergoing intensity-modulated radiation therapy (IMRT) for cervical cancer. In this study, we evaluated the feasibility of a weekly image guidance pattern and analyzed the long-term outcomes in a large cohort of patients.
The study enrolled patients with Stage IB-IVA cervical cancer who received definitive radiotherapy or concurrent chemoradiotherapy. IMRT was delivered at a dose of 50.4 Gy in 28 fractions, with weekly cone-beam computed tomography (CBCT). Physicians advised patients on rectum and bladder preparation to help them prepare on nonimaging guidance days. When significant tumor regression was observed, a second computed tomography simulation and replanning were performed.
The median follow-up periods were 63.4 months. The incidence rates of loco-regional and distant failure were 9.9% and 13.6%. The 5-year overall survival (OS), disease-free survival (DFS), loco-regional relapse-free survival (LRFS), and distant metastasis-free survival (DMFS) rates were 80.1%, 72.9%, 78.3%, and 74.8%, respectively. For patients with different stages, the 5-year OS, DFS, LRFS, and DMFS rates were statistically significant. For patients with and without positive regional lymph nodes, the 5-year OS, DFS, LRFS, and DMFS rates were 64.5% and 86.0%, 56.8% and 78.8%, 62.7% and 84.3%, and 58.8% and 81.0%, respectively. Multivariate analysis showed that age, histology, tumor size, cancer stage, pretreatment squamous cell carcinoma antigen level, and para-aortic metastatic lymph nodes were independent prognostic factors of OS. Fifty-six (4.0%) patients experienced late Grade 3/4 chronic toxicities.
IMRT with weekly CBCT is an acceptable image guidance strategy in countries with limited medical resources.
在宫颈癌调强放疗（IMRT）中，推荐使用图像引导。本研究评估了每周图像引导模式的可行性，并对大量患者的长期结果进行了分析。
本研究纳入了接受根治性放疗或同期放化疗的 I B-IVA 期宫颈癌患者。采用 50.4 Gy/28 次分割剂量行 IMRT，每周行锥形束 CT（CBCT）。医生会指导患者在非影像引导日进行直肠和膀胱准备。当观察到明显肿瘤退缩时，会进行第二次 CT 模拟和重新计划。
中位随访时间为 63.4 个月。局部区域和远处失败的发生率分别为 9.9%和 13.6%。5 年总生存率（OS）、无病生存率（DFS）、局部区域无复发生存率（LRFS）和远处无转移生存率（DMFS）分别为 80.1%、72.9%、78.3%和 74.8%。对于不同分期的患者，5 年 OS、DFS、LRFS 和 DMFS 率均有统计学意义。对于有和无区域淋巴结阳性的患者，5 年 OS、DFS、LRFS 和 DMFS 率分别为 64.5%和 86.0%、56.8%和 78.8%、62.7%和 84.3%和 58.8%和 81.0%。多因素分析显示，年龄、组织学、肿瘤大小、癌症分期、治疗前鳞状细胞癌抗原水平和主动脉旁转移性淋巴结是 OS 的独立预后因素。56 例（4.0%）患者发生晚期 3/4 级慢性毒性。
在医疗资源有限的国家，每周行 CBCT 的 IMRT 是一种可接受的图像引导策略。
