Assessment of Parametrial Response by Growth Pattern in Patients With International Federation of Gynecology and Obstetrics Stage IIB and IIIB Cervical Cancer: Analysis of Patients From a Prospective, Multicenter Trial (EMBRACE)
Assessment of Parametrial Response by Growth Pattern in Patients With International Federation of Gynecology and Obstetrics Stage IIB and IIIB Cervical Cancer: Analysis of Patients From a Prospective, Multicenter Trial (EMBRACE)
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DOI：
10.1016/j.ijrobp.2015.08.007
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发表时间：
2015-11-15
影响因子：
7
通讯作者：
Poetter, Richard
中科院分区：
文献类型：
--
作者：
Yoshida, Kenji;Jastaniyah, Noha;Poetter, Richard
目的：根据国际妇产科联合会(FIGO)IIB期和IIIB期宫颈癌患者在影像引导下自适应近距离放射治疗时的肿瘤形态，评估宫旁间隙的疾病反应。方法与材料：对2013年11月纳入研究的FIGO IIB期和IIIB期宫颈癌患者进行评估。根据MRI上肿瘤的形态亚型(扩张型和浸润型)进行分层，并分析各亚型的特点。在诊断时和近距离放射治疗时评估宫旁受累，并将化疗-放射治疗的反应分为良、中、差三类。结果：共评估452例患者，其中膨胀型186例，浸润型266例。浸润性肿瘤的患者有更广泛的疾病，FIGO期IIIB病的比率较高，以及磁共振成像上的放射学证据显示延伸到子宫旁间隙远端和盆腔侧壁。宫颈坏死在浸润性组中更为常见。扩张型组反应良好(34%比24%；P=0.02)，浸润型组反应差(11%和19%；P=0.02)。两组患者确诊时的平均大体肿瘤体积相同(51.7厘米(3))。浸润性肿瘤的高危临床靶区体积较大(37.9 cm(3)vs33.3 cm(3)，P=0.05)。005)。扩张性肿瘤的平均高危临床靶区体积D-90略高(92.7Gy89.4GyP
Purpose: To assess disease response along the parametrial space according to tumor morphology in patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIB and IIIB cervical cancer at the time of image-guided adaptive brachytherapy.Methods and Materials: Patients with FIGO stage IIB and IIIB cervical cancer registered as of November 2013 in the EMBRACE study were evaluated. Tumors were stratified according to morphologic subtype on magnetic resonance imaging (expansive and infiltrative), and the characteristics of those subtypes were analyzed. Parametrial involvement at diagnosis and at brachytherapy was evaluated, and the response to chemo-radiotherapy was classified as good, moderate, or poor. The response grade was compared between the 2 groups and analyzed with regard to tumor volumes, and dosimetric parameters.Results: A total of 452 patients were evaluated, of whom 186 had expansive growth type and 266 had infiltrative morphology. Patients with infiltrative tumors had more extensive disease, as indicated by a higher rate of FIGO stage IIIB disease, as well as radiologic evidence of extension into the distal parametrial space and to the pelvic side wall on magnetic resonance imaging. Cervical necrosis was more common in the infiltrative group. Good response was more common in the expansive group (34% vs 24%; P=.02), and poor response was more common in the infiltrative group (11% and 19%; P=.02). Mean gross tumor volume at diagnosis was equal in both groups (51.7 cm(3)). The high-risk clinical target volume was larger in infiltrative tumors (37.9 cm(3) vs 33.3 cm(3), P = . 005). The mean high-risk clinical target volume D-90 was slightly higher in expansive tumors (92.7 Gy and 89.4 Gy, P