MRI-guided adaptive radiotherapy in locally advanced cervical cancer from a Nordic perspective
MRI-guided adaptive radiotherapy in locally advanced cervical cancer from a Nordic perspective
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DOI：
10.3109/0284186x.2013.818253
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发表时间：
2013-10-01
期刊：
影响因子：
3.1
通讯作者：
Tanderup, Kari
中科院分区：
文献类型：
--
作者：
Lindegaard, Jacob Christian;Fokdal, Lars Ulrik;Tanderup, Kari
背景。北欧第一个针对局部晚期宫颈癌进行三维 (3D) 计划放射治疗的方案是前瞻性 NOCECA 研究（1994-2000）。 NOCECA 包括基于计算机断层扫描 (CT) 的 3D 适形外照射放射治疗 (EBRT)，同时对原发肿瘤进行综合增强 (SIB) 结合基于 X 射线成像的近距离放射治疗 (BT)。在 NOCECA 中，规划目标是通过 EBRT 和 BT 组合在 A 点实现 80 Gy。然而，EBRT 和 BT 之间的剂量平衡取决于诊断时的肿瘤大小，A 点给予较多的 EBRT 剂量，而在晚期阶段则给予较少的 BT 剂量。 2005 年，奥尔胡斯引入了基于磁共振成像 (MRI) 的图像引导自适应近距离放射治疗 (IGABT) 以及优化 BT 时剩余肿瘤和宫颈的 BT 剂量分布 (HR CTV)。 EBRT 一直与 NOCECA 类似，直到 2008 年放弃对原发肿瘤的 SIB，并引入 IMRT 作为常规技术。在这项研究中，我们使用我们的 NOCECA 队列作为参考，报告了我们第一个五年 IGABT 经验的结果。材料和方法。由 99 名患者组成的 NOCECA 队列与接受 IGABT 治疗的 140 名连续患者进行了比较。有主动脉旁淋巴结的患者在 NOCECA 中被排除，但在接受 IGABT 治疗的患者中 9% 存在。 NOCECA 中没有患者接受化疗，而 79% 的 IGABT 患者同时接受顺铂治疗。结果。 IGABT 精算的三年本地控制率为 91%。将 NOCECA 与 IGABT 进行比较时，总生存率从 63% 显着提高至 79% (p = 0.005)。与此同时，中度和重度晚期发病率均降低了约 50% (p = 0.02)。结论。 IGABT 的引入降低了发病率并产生了非常高的局部控制率，这可能至少与伴随化疗一样提高了生存率。
Background. The first Nordic protocol for three-dimensional (3D) planned radiotherapy in locally advanced cervical cancer was the prospective NOCECA study (1994-2000). NOCECA consisted of computed tomography (CT)-based 3D conformal external beam radiotherapy (EBRT) with a simultaneous integrated boost (SIB) to the primary tumour combined with brachytherapy (BT) based on x-ray imaging. In NOCECA the planning aim was to achieve 80 Gy at point A from EBRT and BT combined. However, the balance of dose between EBRT and BT was determined by tumour size at diagnosis with more EBRT dose given to point A and less by BT in more advanced stages. In 2005 image-guided adaptive brachytherapy (IGABT) based on magnetic resonance imaging (MRI) and optimisation of the BT dose distribution to the remaining tumour and cervix at time of BT (HR CTV) was introduced in Aarhus. EBRT remained like in NOCECA until 2008 when the SIB to the primary tumour was abandoned and IMRT was introduced as routine technique. In this study, we report outcome of our first five-year experience with IGABT using our NOCECA cohort as reference. Material and methods. The NOCECA cohort comprising 99 patients was compared with 140 consecutive patients treated by IGABT. Patients with para-aortic nodes were excluded in NOCECA but were present in 9% of the patients treated with IGABT. No patient in NOCECA received chemotherapy whereas concomitant cisplatin was given to 79% of the IGABT patients. Results. With IGABT actuarial local control was 91% at three years. When comparing NOCECA with IGABT overall survival was significantly improved from 63% to 79% (p = 0.005). In parallel, both moderate and severe late morbidity were reduced by about 50% (p = 0.02). Conclusion. Introduction of IGABT reduced morbidity and generated a very high rate of local control, which likely has improved survival by at least as much as concomitant chemotherapy.