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挽救性外照射放疗联合组织间近距离放疗治疗局部晚期复发性子宫内膜癌后的临床结局

Clinical outcomes after salvage external beam radiotherapy combined with interstitial brachytherapy for locally advanced, recurrent endometrial cancer.

作者信息

Waheed Asmara, Banerjee Robyn, Meyer Tyler, Quirk Sarah, Doll Corinne, McGeachy Philip, Phan Tien, Roumeliotis Michael, Martell Kevin

机构信息

Department of Oncology University of Calgary, Tom Baker Cancer Center Calgary Alberta Canada.

出版信息

Precis Radiat Oncol. 2023 Jan 24;7(1):45-50. doi: 10.1002/pro6.1185. eCollection 2023 Mar.

Abstract

Salvage external beam radiation therapy (EBRT) followed by interstitial brachytherapy is commonly used to treat patients with vaginal recurrence of endometrial cancer. The evidence for this is typically limited to case series treating small volumes of disease. For the present study, 12 consecutive patients with locally advanced, biopsy-proven vaginal recurrence after surgically treated endometrial cancer who received salvage EBRT (45 Gy in 25 daily fractions to microscopic disease and 55-57.5 Gy to gross nodal disease) with magnetic resonance-guided interstitial brachytherapy (20-21 Gy in 3 fractions over 2 days) were retrospectively reviewed. The median tumor size of recurrent disease on magnetic resonance imaging was 5 (3-6) cm. Three (25%) tumors involved the bladder wall, three (25%) involved the urethra, and four (33%) extended to the pelvic sidewall. Four (25%) patients had gross nodal disease. On follow-up, no (0%) patient developed local recurrence. One patient (8%) developed nodal recurrence outside of the radiotherapy treatment volume and then distant metastases, and one patient (8%) developed distant metastasis 2.5 years post-treatment and subsequently died from the disease. No (0%) other deaths were reported. Zero patients (0%) developed grade ≥4 bowel or bladder toxicity. These data support EBRT with interstitial brachytherapy using modern techniques for locally advanced, vaginal recurrences of endometrial cancer.

摘要

挽救性外照射放疗(EBRT)联合组织间近距离放疗常用于治疗子宫内膜癌阴道复发患者。对此的证据通常仅限于治疗小体积疾病的病例系列。在本研究中,对12例经手术治疗的子宫内膜癌后出现局部晚期、经活检证实阴道复发的患者进行了回顾性分析,这些患者接受了挽救性EBRT(对微小病灶给予45 Gy,分25次每日照射,对大体淋巴结病灶给予55 - 57.5 Gy)联合磁共振引导的组织间近距离放疗(在2天内分3次给予20 - 21 Gy)。磁共振成像上复发疾病的中位肿瘤大小为5(3 - 6)cm。3例(25%)肿瘤累及膀胱壁,3例(25%)累及尿道,4例(33%)延伸至盆腔侧壁。4例(25%)患者有大体淋巴结病灶。随访时,无(0%)患者出现局部复发。1例患者(8%)在放疗靶区外出现淋巴结复发,随后发生远处转移,1例患者(8%)在治疗后2.5年出现远处转移,随后死于该疾病。未报告其他死亡病例。0例患者(0%)出现≥4级肠道或膀胱毒性反应。这些数据支持采用现代技术进行EBRT联合组织间近距离放疗治疗局部晚期子宫内膜癌阴道复发。

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