Intensity Modulated Radiation Therapy and Image-Guided Adapted Brachytherapy for Cervix Cancer
Intensity Modulated Radiation Therapy and Image-Guided Adapted Brachytherapy for Cervix Cancer
复制标题
DOI：
10.1016/j.ijrobp.2018.11.012
复制
发表时间：
2019-04-01
影响因子：
7
通讯作者：
Grigsby, Perry W.
中科院分区：
文献类型：
--
作者：
Lin, Alexander J.;Kidd, Elizabeth;Grigsby, Perry W.
目的：本研究报告了宫颈癌患者接受强度调节放疗和三维（3D）图像引导适应近距离放疗（IMRT/3D- igabt）治疗与接受二维（2D）外照射和二维近距离放疗（2D EBRT/BT）治疗的长期结果。方法与材料：本研究纳入1997 - 2013年接受治疗意图照射治疗的新诊断宫颈癌患者和预处理氟脱氧葡萄糖正电子发射断层扫描。2005年，治疗政策由2D EBRT/BT改为IMRT/3D-IGABT。评估复发模式、癌症特异性生存期（CSS）和总生存期（OS）。根据美国国家癌症研究所不良事件通用术语标准对晚期胃肠道和泌尿生殖系统毒性进行评分。结果：在最后一次随访时，2D EBRT/BT组（n = 300）存活患者的中位随访时间为15.3年（范围为10.8-20.5年）。IMRT/3D-IGABT组（n = 300）为7年（范围5-12.4年）。据国际妇产科联合会统计，33%的肿瘤为IB1 ~ IB2期，41%为IIA ~ IIB期，26%为IIIA ~ IVA期。接受2D EBRT/BT治疗5年后的结果显示，复发自由（FFR）为57%，CSS为62%，OS为57%。对于IMRT/3D-IGABT组，5年结果显示FFR为65% (P= 0.04)， CSS为69% (P= 0.01)， OS为61% （P= 0.04）。当根据正电子发射断层扫描结果对淋巴结状态进行分层时，仅盆腔淋巴结阳性的患者，IMRT/3D-IGABT与2D EBRT/BT相比，疾病控制得到了最大的改善（P= 0.02）。累计600例患者中88例（15%）为>= 3级晚期肠/膀胱毒性。2D EBRT/BT组55例（18%），IMRT/3D-IGABT组33例（11%；P= 0.02）。结论：与接受2D EBRT/BT的宫颈癌患者相比，IMRT/3D-IGABT可提高宫颈癌患者的生存率，降低胃肠道和泌尿生殖系统毒性。(C) 2018爱思唯尔公司版权所有。
Purpose: This study reported long-term outcomes of patients with cervical cancer who were treated with intensity modulated radiation therapy and 3-dimensional (3D) image-guided adapted brachytherapy (IMRT/3D-IGABT) compared with those treated with 2-dimensional (2D) external irradiation and 2D brachytherapy (2D EBRT/BT).Methods and Materials: This study included patients with newly diagnosed cervical cancer and pretreatment fluorodeoxyglucose positron emission tomography scans who were treated with curative-intent irradiation from 1997 to 2013. The treatment policy changed from using 2D EBRT/BT to IMRT/3D-IGABT in 2005. Patterns of recurrence, cancer-specific survival (CSS), and overall survival (OS) were evaluated. Late gastrointestinal and genitourinary toxicity were scored with National Cancer Institute Common Terminology Criteria for Adverse Events.Results: The median follow-up for patients alive at the time of last follow-up in the 2D EBRT/BT group (n = 300) was 15.3 years (range, 10.8-20.5 years). In the IMRT/3D-IGABT group (n = 300), it was 7 years (range, 5-12.4 years). According to the International Federation of Gynecology and Obstetrics, 33% of tumors were stage IB1 to IB2, 41% were stage IIA to IIB, and 26% were stage IIIA to IVA. The results after 5 years for patients treated with 2D EBRT/BT showed that freedom from relapse (FFR) was 57%, CSS was 62%, and OS was 57%. For the IMRT/3D-IGABT group, the 5-year results showed that FFR was 65% (P=.04), CSS was 69% (P=.01), and OS was 61% (P=.04). When stratified by lymph node status according to positron emission tomography scan results, disease control was most improved with IMRT/3D-IGABT versus 2D EBRT/BT in patients with positive pelvic lymph nodes only (P=.02). Cumulatively, 88 of 600 patients (15%) had grade >= 3 late bowel/bladder toxicity. The 2D EBRT/BT group had 55 patients (18%), and the IMRT/3D-IGABT group had 33 patients (11%; P=.02).Conclusions: IMRT/3D-IGABT was associated with improved survival and decreased gastrointestinal and genitourinary toxicity in patients with cervical cancer compared with those who received 2D EBRT/BT. (C) 2018 Elsevier Inc. All rights reserved.