Wark Antje, Hüfner Laura, Meixner Eva, Oelmann Jan, König Laila, Höne Simon, Lindel Katja, Debus Jürgen, Arians Nathalie
Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
Department of Radiation Oncology, Städtisches Klinikum Karlsruhe, 76133 Karlsruhe, Germany.
Curr Oncol. 2025 Feb 26;32(3):136. doi: 10.3390/curroncol32030136.
This study investigates the clinical efficacy of MRI-based adaptive brachytherapy (IGABT) using combined intracavitary and interstitial techniques in the curative treatment of patients with advanced cervical cancer (LACC). A retrospective analysis was conducted on 149 LACC patients treated at a single center. The therapeutic protocol included intensity-modulated external beam radiotherapy (IMRT) and IGABT. Dosimetric parameters were evaluated for relevance for local control (LC), progression-free survival (PFS), and overall survival (OS) using Kaplan-Meier estimation, Cox regression, and log-rank test. Patients predominantly presented with stage III/IV tumors (81%, FIGO 2018). The median high-risk clinical target volume (hrCTV) was 34 cm, with a median D90% dose of 88.9 GyEQD2. At 24 months, OS, PFS, and LC rates were 86%, 57%, and 81%, respectively. FIGO stage, tumor volume, and histology were significant predictors of PFS. Higher total hrCTV doses were strongly correlated with improved LC and PFS, emphasizing the importance of precise dosimetric optimization in IGABT and confirming the critical role of IGABT in achieving very good LC rates for LACC. The reported LC rates are comparable to landmark studies, such as INTERLACE and KEYNOTE-A18. This study validates the effectiveness of MRI-guided IGABT in enhancing local tumor control in advanced-stage cervical cancer while providing insights into the prognostic implications of dosimetric parameters such as hrCTV and point A. Future research should address the persistent challenge of distant metastases by exploring the integration of novel systemic treatment options.
本研究调查了基于磁共振成像的自适应近距离放射治疗（IGABT）联合腔内和组织间技术在晚期宫颈癌（LACC）患者根治性治疗中的临床疗效。对在单一中心接受治疗的149例LACC患者进行了回顾性分析。治疗方案包括调强外照射放疗（IMRT）和IGABT。使用Kaplan-Meier估计、Cox回归和对数秩检验评估剂量学参数与局部控制（LC）、无进展生存期（PFS）和总生存期（OS）的相关性。患者主要表现为III/IV期肿瘤（81%，国际妇产科联盟2018年分期）。高危临床靶区（hrCTV）的中位数为34 cm，D90%剂量的中位数为88.9 GyEQD2。在24个月时，OS、PFS和LC率分别为86%、57%和81%。国际妇产科联盟分期、肿瘤体积和组织学是PFS的重要预测因素。hrCTV总剂量越高，与LC和PFS的改善密切相关，强调了IGABT中精确剂量学优化的重要性，并证实了IGABT在LACC实现非常好的LC率方面的关键作用。报告的LC率与具有里程碑意义的研究（如INTERLACE和KEYNOTE-A18）相当。本研究验证了磁共振成像引导的IGABT在增强晚期宫颈癌局部肿瘤控制方面的有效性，同时深入了解了hrCTV和A点等剂量学参数的预后意义。未来的研究应通过探索新型全身治疗方案的整合来应对远处转移这一持续挑战。
