Clinical outcome of protocol based image (MRI) guided adaptive brachytherapy combined with 3D conformal radiotherapy with or without chemotherapy in patients with locally advanced cervical cancer.
Clinical outcome of protocol based image (MRI) guided adaptive brachytherapy combined with 3D conformal radiotherapy with or without chemotherapy in patients with locally advanced cervical cancer.
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DOI：
10.1016/j.radonc.2011.07.012
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发表时间：
2011-07
期刊：
影响因子：
--
通讯作者：
Kirisits C
中科院分区：
文献类型：
--
作者：
Pötter R;Georg P;Dimopoulos JC;Grimm M;Berger D;Nesvacil N;Georg D;Schmid MP;Reinthaller A;Sturdza A;Kirisits C
分析基于方案的图像引导适应性近距离放疗联合三维适形外束放疗（EBRT）±化疗（ChT）的总体临床效果和获益。治疗方案为EBRT + 45-50.4 Gy±同期顺铂化疗+ 4 × 7 Gy高剂量率（HDR）近距离治疗。患者在“方案期”（2001-2008年）接受治疗，前瞻性应用高风险CTV概念（D90）和危险器官的剂量体积限制，包括生物模型。剂量体积调整的目的是在大肿瘤中增加剂量（规定D90 bb0 85 Gy），通常需要插入额外的间质针。剂量体积限制（D2cc）：直肠和乙状结肠70 ~ 75 Gy，膀胱90 Gy。使用LENT/SOMA评分对晚期发病率进行前瞻性评分。采用精算分析对疾病结局和治疗相关的晚期发病率进行评估和比较。156例连续FIGO分期IB-IVA宫颈癌患者（中位年龄58岁）接受了明确的放射治疗。组织学为鳞状细胞癌134例（86%），肿瘤大小为bbb5 cm 103例（66%），淋巴结累及75例（48%）。所有患者的中位随访时间为42个月。156例患者中有69例（44%）除腔内近距离放疗外，还使用了间质技术。总处方平均剂量（D90）为93±13 Gy， D2cc为膀胱86±17 Gy，直肠65±9 Gy，乙状结肠64±9 Gy。156例患者中有151例（97%）达到完全缓解。3年的总体局部控制率为95%；2-5 cm为98%，5 - 5 cm为92% (p = 0.04)， IB为100%，IIB为96%，IIIB为86%。3年肿瘤特异性生存率总体为74%，肿瘤2-5厘米为83%，肿瘤5 - 5厘米为70%，IB为83%，IIB为84%，IIIB为52%。3年总生存率为68%，肿瘤2-5 cm为72%，肿瘤5 - 5 cm为65%，IB为74%，IIB为78%，IIIB为45%。在143例患者中，共观察到188例1 + 2级晚期事件和11例3 + 4级晚期事件。膀胱G1 + 2/G3 + 4事件n = 32/3，直肠n = 14/5，肠（含乙状结肠）n = 3/0，阴道n = 128/2。三维适形放疗+化疗+影像（MRI）引导的晚期适应性腔内近距离治疗包括针入治疗，在有限/有利（IB/IIB）的宫颈癌患者中，3年局部控制率为95-100%，在大/差（IIB/III/IV）的宫颈癌患者中，3年局部控制率为85-90%，伴有中等治疗相关发病率。与历史上的维也纳系列相比，盆腔复发率相对降低65-70%，主要发病率降低。本地控件的改进似乎对CSS和OS都有影响。前瞻性临床多中心研究是评估这些具有挑战性的单机构研究结果的必要条件。
To analyse the overall clinical outcome and benefits by applying protocol based image guided adaptive brachytherapy combined with 3D conformal external beam radiotherapy (EBRT) ± chemotherapy (ChT). Treatment schedule was EBRT with 45–50.4 Gy ± concomitant cisplatin chemotherapy plus 4 × 7 Gy High Dose Rate (HDR) brachytherapy. Patients were treated in the “protocol period” (2001–2008) with the prospective application of the High Risk CTV concept (D90) and dose volume constraints for organs at risk including biological modelling. Dose volume adaptation was performed with the aim of dose escalation in large tumours (prescribed D90 > 85 Gy), often with inserting additional interstitial needles. Dose volume constraints (D2cc) were 70–75 Gy for rectum and sigmoid and 90 Gy for bladder. Late morbidity was prospectively scored, using LENT/SOMA Score. Disease outcome and treatment related late morbidity were evaluated and compared using actuarial analysis. One hundred and fifty-six consecutive patients (median age 58 years) with cervix cancer FIGO stages IB–IVA were treated with definitive radiotherapy in curative intent. Histology was squamous cell cancer in 134 patients (86%), tumour size was >5 cm in 103 patients (66%), lymph node involvement in 75 patients (48%). Median follow-up was 42 months for all patients. Interstitial techniques were used in addition to intracavitary brachytherapy in 69/156 (44%) patients. Total prescribed mean dose (D90) was 93 ± 13 Gy, D2cc 86 ± 17 Gy for bladder, 65 ± 9 Gy for rectum and 64 ± 9 Gy for sigmoid. Complete remission was achieved in 151/156 patients (97%). Overall local control at 3 years was 95%; 98% for tumours 2–5 cm, and 92% for tumours >5 cm (p = 0.04), 100% for IB, 96% for IIB, 86% for IIIB. Cancer specific survival at 3 years was overall 74%, 83% for tumours 2–5 cm, 70% for tumours >5 cm, 83% for IB, 84% for IIB, 52% for IIIB. Overall survival at 3 years was in total 68%, 72% for tumours 2–5 cm, 65% for tumours >5 cm, 74% for IB, 78% for IIB, 45% for IIIB. In regard to late morbidity in total 188 grade 1 + 2 and 11 grade 3 + 4 late events were observed in 143 patients. G1 + 2/G3 + 4 events for bladder were n = 32/3, for rectum n = 14/5, for bowel (including sigmoid) n = 3/0, for vagina n = 128/2, respectively. 3D conformal radiotherapy ± chemotherapy plus image (MRI) guided adaptive intracavitary brachytherapy including needle insertion in advanced disease results in local control rates of 95–100% at 3 years in limited/favourable (IB/IIB) and 85–90% in large/poor response (IIB/III/IV) cervix cancer patients associated with a moderate rate of treatment related morbidity. Compared to the historical Vienna series there is relative reduction in pelvic recurrence by 65–70% and reduction in major morbidity. The local control improvement seems to have impact on CSS and OS. Prospective clinical multi-centre studies are mandatory to evaluate these challenging mono-institutional findings.
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DOI：
10.1016/j.ijrobp.2009.11.002
发表时间：
2011-02-01
影响因子：
7
作者：
Georg, Petra;Lang, Stefan;Poetter, Richard
通讯作者：
Poetter, Richard
DOI：
10.1016/j.ijrobp.2008.10.033
发表时间：
2009-09-01
影响因子：
7
作者：
Dimopoulos, Johannes C. A.;Lang, Stefan;Poetter, Richard
通讯作者：
Poetter, Richard
影响因子：
3.1
作者：
Dimopoulos, Johannes C. A.;Schirl, Gertrude;Poetter, Richard
通讯作者：
Poetter, Richard
影响因子：
5.7
作者：
Fidarova, Elena F.;Berger, Daniel;Poetter, Richard
通讯作者：
Poetter, Richard
影响因子：
5.7
作者：
Haie-Meder, Christine;Chargari, Cyrus;Magne, Nicolas
通讯作者：
Magne, Nicolas