Postoperative pelvic intensity-modulated radiation therapy reduced the incidence of late gastrointestinal complications for uterine cervical cancer patients
Postoperative pelvic intensity-modulated radiation therapy reduced the incidence of late gastrointestinal complications for uterine cervical cancer patients
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术后盆腔调强放射治疗降低宫颈癌患者晚期胃肠道并发症的发生率
DOI：
10.1093/jrr/rrz041
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发表时间：
2019
影响因子：
2
通讯作者：
Itami Jun
中科院分区：
文献类型：
--
作者：
Tsuchida Keisuke;Murakami Naoya;Kato Tomoyasu;Okuma Kae;Okamoto Hiroyuki;Kashihara Tairo;Takahashi Kana;Inaba Koji;Igaki Hiroshi;Nakayama Yuko;Nakano Takashi;Itami Jun
本研究的目的是比较宫颈癌根治性子宫切除术后三维适形放射治疗（3DCRT）和调强放射治疗（IMRT）晚期胃肠道不良事件的发生率和临床结果。2007年3月至2014年5月，73例预后高危因素（盆腔淋巴结转移和/或伴侧浸润）的宫颈癌患者在根治性子宫切除术后接受盆腔放疗（RT）。其中33例（45%）和40例（55%）分别接受3DCRT和IMRT治疗。由于术后盆腔3DCRT术后消化道梗阻率较高，直到2015年才同步化疗。3DCRT和IMRT患者的中位随访时间分别为82个月（6-113）和50个月（5-74）。两组总生存期（4年生存期：85% vs 78%，P= 0.744）或无病生存期（4年生存期：73% vs 64%，P= 0.696）无显著差异。3DCRT和IMRT术后分别有11例（33%）和13例（33%）出现复发。术后病理发现有阴道侵犯的患者比无阴道侵犯的患者更容易出现局部-区域复发（2.3% vs 17%，P= 0.033）。3DCRT组和IMRT组分别有9例（27%）和3例（7.5%）出现胃肠道梗阻（P =0.026）。6例（19%）患者出现严重肠梗阻，需行手术治疗，均行3DCRT辅助放疗。与3DCRT相比，IMRT可降低盆腔术后晚期严重胃肠梗阻的发生率，临床疗效不逊色。
The aim of the study was to compare incidences of late gastrointestinal adverse events and clinical outcomes between 3D conformal radiation therapy (3DCRT) and intensity-modulated radiation therapy (IMRT) after radical hysterectomy for cervical cancer patients. Between March 2007 and May 2014, 73 cervical cancer patients with high-risk prognostic factors (pelvic lymph node metastasis and/or parametrial invasion) underwent postoperative pelvic radiation therapy (RT) after radical hysterectomy. Of these patients, 33 (45%) and 40 (55%) received 3DCRT and IMRT, respectively. Because the gastrointestinal obstruction rate after postoperative pelvic 3DCRT was high, no concurrent chemotherapy was applied until 2015. The median follow-up period for patients with 3DCRT and IMRT was 82 months (6–113) and 50 months (5–74), respectively. There was no significant difference in overall survival (OS) (4-year OS: 85% vs 78%,P= 0.744) or disease-free survival (DFS) (4-year DFS: 73% vs 64%,P= 0.696) between the two groups. Eleven (33%) and 13 (33%) patients experienced recurrence after 3DCRT and IMRT, respectively. The patients who had vaginal invasion from the postoperative pathological finding more frequently had loco-regional recurrence than the patients who did not have vaginal invasion (2.3% vs 17%,P= 0.033). Gastrointestinal obstruction was observed in 9 (27%) and 3 (7.5%) patients for 3DCRT and for IMRT, respectively (P =0.026). Severe gastrointestinal obstruction that required surgery was observed in 6 (19%) patients, all of whom received adjuvant RT by 3DCRT. IMRT could reduce the incidence of late severe gastrointestinal obstruction after postoperative pelvic RT with a non-inferior clinical efficacy compared with 3DCRT.