Exclusive radiotherapy for primary squamous cell carcinoma of the vagina
Exclusive radiotherapy for primary squamous cell carcinoma of the vagina
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DOI：
10.1016/j.radonc.2007.09.015
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发表时间：
2007-12-01
影响因子：
5.7
通讯作者：
Haie-meder, Christine
中科院分区：
文献类型：
--
作者：
de Crevoisier, Renaud;Sanfilippo, Nicholas;Haie-meder, Christine
目的：回顾性分析1970 ~ 2001年91例原发性阴道鳞状细胞癌（PVSCC）的体外放射治疗（EBT）和近距离放射治疗（BT）结果。FIGO分期为：I（29%）、II（38%）、III（29%）和IVa（4%）。EBT向骨盆输送的中位总剂量为50戈伊。BT使用定制的阴道内施源器进行，36%的应用结合腔内和间质BT。结果：5年病因特异性生存率（CSS）：I期83%，II期76%，III期52%，IVa期2例分别于治疗后9个月和36个月死亡。5年骨盆控制率为：I期和II期为79%，III期为62%。作为首次事件的复发仅在68%的病例中为局部复发，仅在10%的病例中为淋巴结复发，仅在13%的病例中为转移性复发，9%的病例中为合并复发。在多变量分析中：阶段（I和II与II和IV），对EBT的反应（在BT评估），以及BT应用的数量对于CSS具有统计学意义。2-3级毒性如下（法语-意大利语词汇表）：直肠（n = 3）、乙状结肠和小肠（n = 8）、膀胱（n = 5）、输尿管（n = 4）和阴道（n = 13）。肿瘤的前部位置增加膀胱毒性（p=0.01），并且在经历2-3级泌尿或消化道毒性的患者中总参考空气比释动能更高（p=0.03）。晚期毒性的发生率和严重程度相对较低。宫颈癌治疗的最新进展强调需要在III-IV期同时进行放射化学治疗和使用MRI进行治疗计划。(c)2007爱思唯尔爱尔兰有限公司保留所有权利。
Purpose: To retrospectively analyze results of external beam therapy (EBT) with brachytherapy (BT) for primary vaginal squamous cell carcinoma (PVSCC).Materials and methods: From 1970 to 2001, 91 patients were included. FIGO stages were: I (29%), II (38%), III (29%) and lVa (4%). EBT delivered a median total dose of 50 Gy to the pelvis. BT was performed with a customized intra-vaginal applicator and in 36% of applications combined endocavitary and interstitial BT. ICRU Report 38 parameters were reported.Results: The 5-year cause specific survival (CSS) rates were: 83% for stage I, 76% for stage II, 52% for stage III, and 2 of the 4 stage IVa patients died 9 and 36 months after treatment. The 5-year pelvis control rates were: 79% for stage I and II and 62% for stage III. Recurrences as a first event were local only in 68% of cases, nodal only in 10%, metastatic only in 13% and combined in 9%. In multivariate analysis: stage (I and II versus II and IV), response to EBT (evaluated at BT), and the number of BT applications were statistically significant for CSS. Grade 2-3 toxicities were as follows (Franco-Italian Glossary): rectum (n = 3), sigmoid colon and small bowel (n = 8), bladder (n = 5), ureter (n = 4) and vagina (n = 13). Anterior location of the tumor increased bladder toxicity (p=0.01) and total reference air kerma was higher in patients who experienced grade 2-3 urinary or digestive toxicity (p=0.03).Conclusion: EBT with BT is an effective treatment for patients with stage I-II PVSCC. The incidence and severity of late toxicity were relatively low. Recent advances in the treatment of cervix carcinoma emphasize the need for concomitant radio-chemotherapy in stages III-IV and the use of MRI for treatment planning. (c) 2007 Elsevier Ireland Ltd. All rights reserved.