Reirradiation Using High-Dose-Rate Interstitial Brachytherapy for Locally Recurrent Cervical Cancer A Single Institutional Experience
Reirradiation Using High-Dose-Rate Interstitial Brachytherapy for Locally Recurrent Cervical Cancer A Single Institutional Experience
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DOI：
10.1097/igc.0000000000000028
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发表时间：
2014-01-01
影响因子：
4.8
通讯作者：
Kimura, Tadashi
中科院分区：
文献类型：
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作者：
Mabuchi, Seiji;Takahashi, Ryoko;Kimura, Tadashi
目的探讨高剂量率组织间近距离放射治疗（HDR-ISBT）对复发性宫颈癌再照射的有效性和可行性。收集了关于原发病、随访结果、复发、治疗结果和毒性的数据。采用考克斯比例风险回归模型进行多变量分析，以确定HDR-ISBT应答的预测因素。采用Kaplan-Meier法计算生存率，并采用logrank test.Results进行比较，共纳入52例接受HDR-ISBT再照射的患者。局部控制率为76.9%（40/52），中位复发后生存期为32个月。在13例患者（25%）中观察到3级或4级晚期毒性。多因素分析显示，肿瘤大小和无治疗间隔是复发后生存率的显著不良预后因素。在比较采用HDR-ISBT再照射（ISBT组）和单纯姑息治疗（姑息组）的患者时，我们发现在显示0或1个不良预后因素的患者中，ISBT组患者的生存时间明显长于姑息组。与此相反，类似的生存率在两组中的患者有2个或更多的预后不良factors.Conclusions再照射使用HDR-ISBT是有效的和可行的复发性宫颈癌患者。我们的2-临床变量预后模型可能使医生能够识别不会从HDR-ISBT中获得临床益处的患者，并为他们提供接受其他类型治疗的机会。
Objectives This study aimed to evaluate the effectiveness and feasibility of reirradiation using high-dose-rate interstitial brachytherapy (HDR-ISBT) in patients with recurrent cervical cancer.Methods The records of 52 consecutive women with central pelvic recurrence who were salvaged with HDR-ISBT-based reirradiation were retrospectively reviewed. Data regarding the primary disease, follow-up findings, recurrence, the treatment outcome, and toxicities were collected. Multivariate analysis was performed using the Cox proportional hazards regression model to identify predictors of the response to HDR-ISBT. Survival rate was calculated using the Kaplan-Meier method and compared using the log-rank test.Results A total of 52 patients who had been treated with HDR-ISBT-based reirradiation were included in our database. The local control rate was 76.9% (40/52), and the median postrecurrence survival period was 32 months. Grade 3 or 4 late toxicities were observed in 13 patients (25%). Multivariate analysis revealed that tumor size and the treatment-free interval were significant poor prognostic factors of postrecurrence survival. In a comparison between the patients who were salvaged with HDR-ISBT-based reirradiation (ISBT group) and those who were treated with palliative therapy alone (palliative group), we found that among the patients who displayed 0 or 1 poor prognostic factors, the patients in the ISBT group survived significantly longer than those in the palliative group. In contrast, similar survival rates were seen in both groups among the patients with 2 or more poor prognostic factors.Conclusions Reirradiation using HDR-ISBT is effective and feasible in patients with recurrent cervical cancer. Our 2-clinical variable prognostic model might enable physicians to identify patients who would not derive clinical benefit from HDR-ISBT and offer them the opportunity to receive other types of treatment.