Guevara Barrera Diana, Rodríguez Villalba Silvia, Suso-Martí Luis, Sanchis-Sánchez Enrique, Perez-Calatayud Jose, Lago Martín Jose Domingo, Blázquez Molina Francisco, Santos Ortega Manuel
Catholic University of Valencia San Vicente Mártir. Doctoral School, Valencia, Spain; Radiation Oncology Department, Hospital Clínica Benidorm, Benidorm, Alicante, Spain.
Radiation Oncology Department, Hospital Clínica Benidorm, Benidorm, Alicante, Spain.
Brachytherapy. 2025 Jan-Feb;24(1):134-143. doi: 10.1016/j.brachy.2024.10.005. Epub 2024 Nov 17.
To compare dosimetric characteristics, clinical outcomes, and toxicity in patients with locally advanced cervical cancer(LACC) treated with transperineal interstitial brachytherapy(P-ISBT), using CT-based planning or MRI-based planning with a monoinstitutional MRI-compatible applicator, Template Benidorm(TB).
We retrospectively analyzed 106 women treated with P-ISBT for LACC from 2006 to 2022. P-ISBT was CT-based, with Martinez Universal Perineal Interstitial Template(MUPIT) between 2006 and 2012, or MRI-based planning (TB) since 2013. Volumetric, clinical, and dosimetric parameters were compared between applicators.
Forty-six (43.4%) patients were treated with MUPIT, and 60 (56.6%) with TB. Median follow-up was 42 months (4-188). No significant difference was observed in 5-year local control (LC), regional control (RC), distant failure (DF), overall survival (OS), and disease-specific survival (DSS) between applicators. The TB cohort had fewer needles (p = 0.001), halved median CTV volume (p < 0.001), increased median DCTV dose (p < 0.005), and lower D values in rectum/bladder (p < 0.001). G3 chronic toxicity was 15% in the MUPIT group and 6% in TB (p = 0.15), with no G4 toxicity reported. Rectal hemorrhage was lower in the TB group (p = 0.002). Larger CTV volumes correlated with higher rectal D2cc and rectal hemorrhage (p = 0.001; p = 0.029, respectively), and enterovaginal fistula (p = 0.03; p < 0.001, respectively). Median CTV volume was 152.82 cc (35.3-256.78) in patients with chronic rectal toxicity and 102.9 cc (21.4-329.41) in those without (p = 0.001).
MRI's superior CTV-volume definition results in smaller treatment volumes, lower D for rectum and bladder, and a trend towards higher CTV D. Rectal hemorrhage was significantly lower in the MRI-based group. A significant correlation was observed between larger CTV-volumes, higher rectal D and rectal hemorrhage/enterovaginal fistula.
比较采用经会阴间质近距离放疗（P-ISBT）治疗的局部晚期宫颈癌（LACC）患者的剂量学特征、临床结局和毒性，这些患者使用基于CT的计划或基于MRI的计划以及单机构MRI兼容施源器贝尼多姆模板（TB）。
我们回顾性分析了2006年至2022年期间接受P-ISBT治疗的106例LACC女性患者。2006年至2012年期间，P-ISBT采用基于CT的马丁内斯通用会阴间质模板（MUPIT），自2013年起采用基于MRI的计划（TB）。比较了两种施源器的体积、临床和剂量学参数。
46例（43.4%）患者采用MUPIT治疗，60例（56.6%）采用TB治疗。中位随访时间为42个月（4 - 188个月）。两种施源器在5年局部控制（LC）、区域控制（RC）、远处失败（DF）、总生存（OS）和疾病特异性生存（DSS）方面未观察到显著差异。TB队列的针数较少（p = 0.001），CTV中位体积减半（p < 0.001），DCTV中位剂量增加（p < 0.005），直肠/膀胱的D值较低（p < 0.001）。MUPIT组3级慢性毒性为15%，TB组为6%（p = 0.15），未报告4级毒性。TB组直肠出血较低（p = 0.002）。较大的CTV体积与较高的直肠D2cc和直肠出血相关（分别为p = 0.001；p = 0.029），以及与肠阴道瘘相关（分别为p = 0.03；p < 0.001）。慢性直肠毒性患者的CTV中位体积为152.82 cc（35.3 - 256.78），无慢性直肠毒性患者的CTV中位体积为102.9 cc（21.4 - 329.41）（p = 0.001）。
MRI在CTV体积定义方面的优势导致治疗体积更小，直肠和膀胱的D值更低，以及CTV D有升高趋势。基于MRI的组直肠出血显著更低。观察到较大的CTV体积、较高的直肠D与直肠出血/肠阴道瘘之间存在显著相关性。
