Postoperative pelvic intensity-modulated radiotherapy and concurrent chemotherapy in intermediate- and high-risk cervical cancer
Postoperative pelvic intensity-modulated radiotherapy and concurrent chemotherapy in intermediate- and high-risk cervical cancer
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DOI：
10.1016/j.ygyno.2012.11.012
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发表时间：
2013-02-01
影响因子：
4.7
通讯作者：
Alektiar, Kaled M.
中科院分区：
文献类型：
--
作者：
Folkert, Michael R.;Shih, Karin K.;Alektiar, Kaled M.
Objective.根据国家调查，强度调制放射治疗（IMRT）在妇科癌症中的使用正在增加，但仍有一些不愿意采用辅助IMRT作为标准实践。本研究的目的是报告一个单一的机构的经验，使用术后盆腔调强放疗与同期化疗中，高风险的早期宫颈癌。2004年1月至2009年12月，34例患者因早期宫颈癌接受了广泛子宫切除术和盆腔淋巴结清扫术（切除28个正中淋巴结）。术后盆腔IMRT的中位剂量为50.4戈伊（范围，45-50.4）。所有患者均同时接受顺铂治疗。中位随访44个月，3例患者复发; 1例阴道复发，1例局部和远处复发，1例远处复发。3年和5年无病生存率（DFS）为91.2%（95%CI，81.4-100%），总生存率（OS）为91.1%（95%CI，81.3-100%）。所有失败和所有死亡均发生在高风险组（n = 3/26）。3 -4级血液学毒性占32.3%，3级急性胃肠道毒性占2.9%，无3级或更高级别的急性泌尿生殖系统毒性。无慢性G3或更高毒性。术后调强放疗的肿瘤结局非常好，中位随访44个月时DFS和OS率>90%，尽管高危特征占优势（76.5%）。即使在积极的三模态方法的设置中，毒性也是最小的。本研究的数据和II期RTOG研究（0418）的新数据证明了术后调强放疗在早期宫颈癌中的优势。(c)2012 Elsevier Inc. All rights reserved.
Objective. According to national surveys, the use of intensity-modulated radiation therapy (IMRT) in gynecologic cancers is on the rise, yet there is still some reluctance to adopt adjuvant IMRT as standard practice. The purpose of this study is to report a single-institution experience using postoperative pelvic IMRT with concurrent chemotherapy in intermediate- and high-risk early stage cervical cancer.Methods. From 1/2004 to 12/2009, 34 patients underwent radical hysterectomy and pelvic lymph node dissection (28 median nodes were removed) for early stage cervical cancer. Median dose of postoperative pelvic IMRT was 50.4 Gy (range, 45-50.4). All patients received concurrent cisplatin.Results. With a median follow-up of 44 months, 3 patients have recurred; 1 vaginal recurrence, 1 regional and distant, and 1 distant. The 3- and 5-year disease-free survival (DFS) was 91.2% (95% CI, 81.4-100%) and overall survival (OS) was 91.1% (95% CI, 81.3-100%). All failures and all deaths were in the high-risk group (n = 3/26). There was 32.3% G3-4 hematologic toxicity, 2.9% acute G3 gastrointestinal toxicity, and no acute G3 or higher genitourinary toxicity. There were no chronic G3 or higher toxicities.Conclusions. Oncologic outcomes with postoperative IMRT were very good, with DFS and OS rates of >90% at median follow-up of 44 months, despite a preponderance (76.5%) of high-risk features. Toxicity was minimal even in the setting of an aggressive trimodality approach. Data from this study and emerging data from the Phase II RTOG study (0418) demonstrate the advantages of postoperative IMRT in early stage cervical cancer. (c) 2012 Elsevier Inc. All rights reserved.