Image guided brachytherapy in locally advanced cervical cancer: Improved pelvic control and survival in RetroEMBRACE, a multicenter cohort study
Image guided brachytherapy in locally advanced cervical cancer: Improved pelvic control and survival in RetroEMBRACE, a multicenter cohort study
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DOI：
10.1016/j.radonc.2016.03.011
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发表时间：
2016-09-01
影响因子：
5.7
通讯作者：
Lindegaard, Jacob Christian
中科院分区：
文献类型：
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作者：
Sturdza, Alina;Poetter, Richard;Lindegaard, Jacob Christian
目的：图像引导下的局部晚期宫颈癌近距离放射治疗（IGBT）允许剂量上升到高危临床靶体积（HRCTV），同时保留危险器官（OAR）。这是第一份关于大型多机构队列临床结果的综合报告。患者和方法：对来自12个中心的731例患者进行了分析，这些患者接受了明确的EBRT同步化疗和IGBT治疗。计算3/5年的Kaplan-Meier估计值，包括局部控制（LC，主要终点）、骨盆控制（PC）、总生存（OS）、癌症特异性生存（CSS）。610例患者报告G3-4晚期毒性（CTCAEv3.0）。结果：中位随访时间为43个月，FIGO分期IA/IB/IIA占22.8%，IIB占50.4%，IIA- ivb占26.8%。84.8%为鳞状细胞癌；40.5%淋巴结受累。EBRT平均剂量为46 2.5 Gy；77.4%接受同期化疗。平均D90 HRCTV为87 +/- 15 Gy (EQD2(10))，平均D2cc为：膀胱81 +/- 22 Gy，直肠64 +/- 9 Gy，乙状窦66 +/- 10 Gy，肠64 +/- 9 Gy（均为EQD2(3)）。3 - 5年精算LC、PC、CSS、OS分别为91%/89%、87%/84%、79%/73%、74%/65%。3/5年精算LC IB， IIB， IIIB分别为98%/98%，93%/91%,79%/75%。IB、IIB、IIIB 3/5年精算PC分别为96%/96%、89%/87%、73%/67%。精算5年G3-G5患病率分别为5%、7%、5%膀胱、胃肠道、阴道。结论：IGBT联合放化疗可获得良好的LC（91%）、PC（87%）、OS（74%）、CSS(79%)，严重发病率有限。(C) 2016由爱思唯尔爱尔兰有限公司出版。
Purpose: Image guided brachytherapy (IGBT) for locally advanced cervical cancer allows dose escalation to the high-risk clinical target volume (HRCTV) while sparing organs at risk (OAR). This is the first comprehensive report on clinical outcome in a large multi-institutional cohort.Patients and methods: From twelve centres 731 patients, treated with definitive EBRT concurrent chemotherapy followed by IGBT, were analysed. Kaplan-Meier estimates at 3/5 years were calculated for local control (LC, primary endpoint), pelvic control (PC), overall survival (OS), cancer specific survival (CSS). In 610 patients, G3-4 late toxicity (CTCAEv3.0) was reported.Results: Median follow up was 43 months, percent of patients per FIGO stage IA/IB/IIA 22.8%, IIB 50.4%, IIIA-IVB 26.8%. 84.8% had squamous cell carcinomas; 40.5% lymph node involvement. Mean EBRT dose was 46 2.5 Gy; 77.4% received concurrent chemotherapy. Mean D90 HRCTV was 87 +/- 15 Gy (EQD2(10)), mean D2cc was: bladder 81 +/- 22 Gy, rectum 64 +/- 9 Gy, sigmoid 66 +/- 10 Gy and bowel 64 +/- 9 Gy (all EQD2(3)). The 3/5-year actuarial LC, PC, CSS, OS were 91%/89%, 87%/84%, 79%/73%, 74%/65%. Actuarial LC at 3/5 years for IB, IIB, IIIB was 98%/98%, 93%/91%, 79%/75%. Actuarial PC at 3/5 years for IB, IIB, IIIB was 96%/96%, 89%/87%, 73%/67%. Actuarial 5-year G3-G5 morbidity was 5%, 7%, 5% for bladder, gastrointestinal tract, vagina.Conclusion: IGBT combined with radio-chemotherapy leads to excellent LC (91%), PC (87%), OS (74%), CSS (79%) with limited severe morbidity. (C) 2016 Published by Elsevier Ireland Ltd.