DVH parameters and outcome for patients with early-stage cervical cancer treated with preoperative MRI-based low dose rate brachytherapy followed by surgery
DVH parameters and outcome for patients with early-stage cervical cancer treated with preoperative MRI-based low dose rate brachytherapy followed by surgery
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DOI：
10.1016/j.radonc.2009.05.004
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发表时间：
2009-11-01
影响因子：
5.7
通讯作者：
Magne, Nicolas
中科院分区：
文献类型：
--
作者：
Haie-Meder, Christine;Chargari, Cyrus;Magne, Nicolas
背景：据我们所知，到目前为止，还没有MRI引导下的Bt在早期宫颈癌的术前环境中出现DVH数据的报道。患者和方法：39例早期宫颈癌患者(IB1 37例，IIA1例和IIB1例)在术前接受基于MRI的LDR Bt治疗，包括中危CTV的子宫阴道Bt总剂量为60Gy6周后行双侧输卵管卵巢切除和筋膜外子宫切除加盆腔淋巴结清扫术。结果：中位随访时间4.4年(2.6~6.6年)，1例局部复发(盆腔外侧复发)(2.6%)。4年总生存率和无瘤生存率分别为94%(95%CI，82~98)和86%(95%CI，67~95)。2年和4年无复发生存率分别为94(95%CI，86~100)和91%(95%CI，81~100)。对于中危CTV，D-100和D-90的中位数分别为43(α/β10)(范围2-74(α/β10))和75((α/β10)，范围29-129(α/β10))。对于高危CTV，D-100和D-90的中位数分别为69(α/β10)(范围24-137(α/β10))和109((α/β10))(范围37-198(α/β10))。13例(33.3%)发生1~2级晚期并发症20例，其中膀胱10例，输尿管3例，直肠1例，小肠1例，阴道1例，盆腔纤维化1例，周围神经1例，其他2例。无3级或4级并发症发生。结论：在早期宫颈癌的术前环境中，MRI引导下的适时适长的近距离放射治疗，既有较高的局部控制率，又有较低的毒性。(C)2009爱思唯尔爱尔兰有限公司。保留所有权利。放射治疗与肿瘤学93(2009)316-321
Background: To our knowledge no DVH data have so far been reported for MRI-guided BT in the preoperative setting of early-stage cervical cancer. We assessed DVH parameters and clinical outcome using 3D MRI-guided preoperative intracavitary LDR BT.Patients and methods: Thirty-nine patients with primary early cervical carcinoma (IB1 37, IIA 1 and IIB 1) were treated with preoperative MRI-based LDR BT, consisting of uterovaginal BT to a total dose of 60 Gy to the intermediate-risk CTV, followed 6 weeks later by bilateral salpingo-oophorectomy and extrafascial hysterectomy plus pelvic node dissection. Adjuvant chemoradiation was delivered to patients with pelvic lymph node involvement.Results: With a median follow-up of 4.4 years (range 2.6-6.6 years), local recurrence occurred in 1 patient (a lateropelvic relapse) (2.6%). The 4-year actuarial overall survival and disease-free survival were 94% (95% CI, 82-98), and 86% (95% CI, 67-95), respectively. The 2- and 4-year actuarial local relapse-free survival were 94 (95% CI, 86-100) and 91% (95% CI, 81-100), respectively. For intermediate-risk CTV, median D-100 and D-90 were 43 Gy(alpha/beta 10) (range 2-74 Gy(alpha/beta 10)) and 75 Gy(alpha/beta 10), respectively (range 29-129 Gy(alpha/beta 10)). For high-risk CTV, the median D-100 and D-90 were 69 Gy(alpha/beta 10) (range 24-137 Gy(alpha/beta 10)) and 109 Gy(alpha/beta 10) (range 37-198 Gy(alpha/beta 10)), respectively. Twenty grade 1-2 late complications were observed in 13 patients (33.3%): 10 bladder, 3 ureteral, 1 rectal, 1 small bowel, 1 vaginal, 1 pelvic fibrosis, 1 peripheral nerve, and 2 others. No grade 3 or 4 complication occurred.Conclusion: MRI-guided brachytherapy with adaptation of the time duration and/or the length of each radioactive source allows both high local control and low toxicity in the preoperative settings of early-stage cervical cancers. (C) 2009 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 93 (2009) 316-321