Hanna Samir A, Silva Alice R N S, de Brito Leticia Hernandes, de Siqueira Gabriela Silva Moreira, Alves Tatiana Midori Martins Teles, de Freitas Daniela, Linck Rudinei, Sadalla José Carlos, Nicolau Sergio Mancini, Buchpiguel Carlos, Carvalho Jesus Paula
Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil.
Department of Radiation Therapy, Hospital Sirio-Libanes, Sao Paulo, Brazil.
Rep Pract Oncol Radiother. 2025 Feb 19;29(6):754-763. doi: 10.5603/rpor.104018. eCollection 2024.
The objective was to evaluate clinical outcomes and toxicity of patients with cervical cancer treated by radiotherapy with dose escalation in involved lymph nodes based on positron emission tomography/computed tomography (PET/CT) staging.
Retrospective cohort study involving locally advanced cervical neoplasms treated with definitive radiotherapy. Volumetric modulated arc therapy (VMAT), image-guided radiotherapy (IGRT), and registration of PET/CT were employed in all. Involved lymph nodes were given higher doses simultaneously.
Between February 2012 and September 2023, there were 37 patients, with median age of 48 (range 27-91) years. Almost 70% were stages III/IVA. Two-thirds were given retroperitoneal irradiation. The mean delivered doses to primary tumor and to involved lymph nodes were, respectively, 52.5 Gy, and 62.5 Gy. The 10-year rates of overall survival, event-free survival, local-recurrence-free survival, and metastasis-free survival were, respectively, 76%, 50%, 91%, and 82%. There were 13 and 2 cases of gastrointestinal toxicity grades II and III, respectively. Grades II and III of genitourinary toxicity were seen respectively in 7 and 3 patients. On univariate analysis, age was related to local recurrence-free survival (LRFS); standard uptake values (SUV) was related to event-free survival (EFS); lymph node dose was related to overall survival (OS), and EFS; primary tumor dose was directly related to EFS, albeit inversely to the likelihood of grade > II gastrointestinal toxicity. Retroperitoneal irradiation improved LRFS, and rates of grade > II gastrointestinal toxicity. On multivariate analysis, SUV remained an independent predictor of EFS; lymph node dose was an independent predictor of OS, and age was an independent predictor of lymph node recurrence.
Dose escalation radiotherapy (RT) based on PET/CT for cervical cancer may be feasible and safe. Further robust study results are needed.
目的是评估基于正电子发射断层扫描/计算机断层扫描（PET/CT）分期对累及淋巴结进行剂量递增放疗的宫颈癌患者的临床结局和毒性。
回顾性队列研究，纳入接受根治性放疗的局部晚期宫颈肿瘤患者。所有患者均采用容积调强弧形放疗（VMAT）、图像引导放疗（IGRT）以及PET/CT配准。同时对累及淋巴结给予更高剂量。
2012年2月至2023年9月期间，共有37例患者，中位年龄48岁（范围27 - 91岁）。近70%为III/IVA期。三分之二的患者接受了腹膜后照射。原发肿瘤和累及淋巴结的平均给予剂量分别为52.5 Gy和62.5 Gy。10年总生存率、无事件生存率、无局部复发生存率和无转移生存率分别为76%、50%、91%和82%。分别有13例和2例患者出现II级和III级胃肠道毒性。分别有7例和3例患者出现II级和III级泌尿生殖系统毒性。单因素分析显示，年龄与无局部复发生存率（LRFS）相关；标准摄取值（SUV）与无事件生存率（EFS）相关；淋巴结剂量与总生存率（OS）和EFS相关；原发肿瘤剂量与EFS直接相关，尽管与>II级胃肠道毒性的可能性呈负相关。腹膜后照射改善了LRFS以及>II级胃肠道毒性的发生率。多因素分析显示，SUV仍然是EFS的独立预测因素；淋巴结剂量是OS的独立预测因素，年龄是淋巴结复发的独立预测因素。
基于PET/CT的宫颈癌剂量递增放疗可能是可行且安全的。需要进一步有力的研究结果。
