Barrera Diana Guevara, Villalba Silvia Rodríguez, Suso-Martí Luis, Sanchis-Sánchez Enrique, Perez-Calatayud Jose, Molina Francisco Blázquez, Pérez-Calatayud Maria Jose, Ortega Manuel Santos
Universidad Católica de Valencia San Vicente Mártir, Escuela de Doctorado, Ciutat Vella, Valencia, Spain.
Radiotherapy Department, Hospital Clínica Benidorm, Benidorm, Alicante, Spain.
J Contemp Brachytherapy. 2024 Oct;16(5):335-343. doi: 10.5114/jcb.2024.144683. Epub 2024 Oct 30.
The purpose of the study was to analyze patients with vaginal-involving recurrences of gynecological tumors and primary vaginal tumors, treated with transperineal interstitial brachytherapy (P-ISBT). Dosimetric, clinical, and toxicity analysis of these patients was conducted, incorporating MRI in volume definition and dose-volume dosimetry.
Forty-two patients were retrospectively analyzed. They were treated with radical or adjuvant intent (in hysterectomized patients with high-risk of relapse). P-ISBT was performed with MUPIT (CT-based planning) in 18 patients (42.9%) and with Template Benidorm (TB) (MRI-based planning) in 24 patients (57.1%).
Median age was 59 years (range, 39-78 years). Median clinical target volume (CTV) was 81.4 cc (range, 33.8-286.2 cc) in MUPIT, and 47.5 cc (range, 10-156.4 cc) in TB-treated patients ( = 0.01). Median EQD for EBRT and brachytherapy D CTV was 69.2 Gy (range, 27.9-88.8 Gy) in MUPIT, and 77.2 Gy (range, 31-84.3 Gy) in TB. Median rectal D was 69.2 Gy (range, 23.5-82.6 Gy) in MUPIT, and 66.3 Gy (range, 16.4-75 Gy) in TB. Median bladder D was 71.5 Gy (range, 23.6-90.8 Gy) in MUPIT, and 66.9 Gy (range, 18.2-78.3 Gy) in TB. Median follow-up was 36.5 months (range, 4-188 months). Local control was 95% at 3 and 5 years. Overall survival was 77% at 3 years, and 66% at 5 years. Disease-specific survival was 81% at 3 years, and 75% at 5 years. Chronic grade 1-2 proctitis presented in 10 patients (24%; 8 treated with MUPIT and 2 treated with TB; = 0.01). Grade 3 toxicity was documented in 4 patients (9.6%).
MRI-based planning is superior to CT-based planning in P-ISBT. It allows for better definition of CTV, resulting in smaller and more selective treatment volumes. Our results show a tendency towards higher D CTV dose and lower rectal/bladder D dose, leading to less events of late rectal toxicity.
本研究旨在分析接受经会阴间质近距离放射治疗（P-ISBT）的妇科肿瘤阴道复发患者和原发性阴道肿瘤患者。对这些患者进行了剂量学、临床和毒性分析，在体积定义和剂量体积剂量测定中纳入了MRI。
对42例患者进行回顾性分析。他们接受了根治性或辅助性治疗（针对有高复发风险的子宫切除患者）。18例患者（42.9%）采用MUPIT（基于CT的计划）进行P-ISBT，24例患者（57.1%）采用Template Benidorm（TB，基于MRI的计划）。
中位年龄为59岁（范围39 - 78岁）。MUPIT组的中位临床靶体积（CTV）为81.4 cc（范围33.8 - 286.2 cc），TB治疗组为47.5 cc（范围10 - 156.4 cc）（P = 0.01）。MUPIT组EBRT和近距离放射治疗D CTV的中位等效剂量（EQD）为69.2 Gy（范围27.9 - 88.8 Gy），TB组为77.2 Gy（范围31 - 84.3 Gy）。MUPIT组直肠D的中位值为69.2 Gy（范围23.5 - 82.6 Gy），TB组为66.3 Gy（范围16.4 - 75 Gy）。MUPIT组膀胱D的中位值为71.5 Gy（范围23.6 - 90.8 Gy），TB组为66.9 Gy（范围18.2 - 78.3 Gy）。中位随访时间为36.5个月（范围4 - 188个月）。3年和5年的局部控制率为95%。3年总生存率为77%，5年为66%。疾病特异性生存率3年为81%，5年为75%。10例患者（24%）出现慢性1 - 2级直肠炎（8例采用MUPIT治疗，2例采用TB治疗；P = 0.01）。4例患者（9.6%）记录到3级毒性反应。
在P-ISBT中，基于MRI的计划优于基于CT的计划。它能更好地定义CTV，从而使治疗体积更小且更具选择性。我们的结果显示有提高D CTV剂量和降低直肠/膀胱D剂量的趋势，导致晚期直肠毒性事件减少。
