Impact of 3D image-based PDR brachytherapy on outcome of patients treated for cervix carcinoma in France: Results of the French STIC prospective study
Impact of 3D image-based PDR brachytherapy on outcome of patients treated for cervix carcinoma in France: Results of the French STIC prospective study
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DOI：
10.1016/j.radonc.2012.04.007
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发表时间：
2012-06-01
影响因子：
5.7
通讯作者：
Peiffert, Didier
中科院分区：
文献类型：
--
作者：
Charra-Brunaud, Claire;Harter, Valentin;Peiffert, Didier
目的：2005年，法国开展了一项多中心非随机前瞻性研究，比较两组接受近距离放射治疗（BT）的宫颈癌患者：2D和3D剂量测定。根据技术的可用性，为每个中心的每位患者选择BT剂量计计划方法。本研究描述了801例可用于分析的患者中705例的结果。患者和方法：对于二维臂，计划使用低剂量率（LDR）或脉冲剂量率（PDR） BT在正交x射线上进行剂量测定，对于三维臂，计划使用3D成像（主要是CT）并使用PDR BT进行剂量测定，每个中心可根据所选择的放射元素和施药器采用他们使用的剂量测定方法。手动或图形优化是允许的。患者和方法：确定三种治疗方案：第一组：BT +手术；165例（2D组76例，3D组89例）；第二组：EBRT +化疗+ BT +手术；305例（2D组142例，3D组163例）；第三组：EBRT +化疗，然后BT；235例患者（2D组118例，3D组117例）。患者和方法：根据GYN GEC ESTRO指南的建议，计算CTV（高风险CTV和中度风险CTV）和危险器官（OARS）的DVH参数。将总剂量换算为2 Gy分数的当量剂量（EQD2）。使用CTCAEv3.0前瞻性评估副作用。结果：2D和3D臂在年龄、FIGO分期、组织学、EBRT剂量和化疗方面平衡良好。对于每个治疗方案，2D组和3D组的BT剂量和体积在到达a点的剂量、等剂量60 Gy的体积、到达ICRU直肠点的剂量和TRAK方面具有可比性。结果：3D臂剂量学数据显示，1组、2组和3组给予90%高危CTV （HR CTV 090）的剂量分别为81.2 Gy（α / β 10）、63.2 Gy（α / β 10）和73.1 Gy（α / β 10）。1、2、3组的中间危险度（IR） CTV D90分别为58.5 Gy（α / β 10）、57.3 Gy（α / β 10）和61.7 Gy（α / β 10）。对于OARs，根据方案，给予D2 cc的剂量范围为膀胱60-70 Gy(α / β 3)，直肠33-61 Gy(α / β 3)，乙状结肠44-58 Gy（α / β 3）。结果：24个月时，第1组局部无复发生存率为91.9%、100%，第2组为84.7%、93%，第3组为73.9%、78.5%；2D和3D臂3-4级毒副率分别为1组14.6%和8.9%，2组12.5%和8.8%，3组22.7%和2.6%。结论：本多中心研究表明三维BT在常规手术中是可行和安全的。它改善了局部控制，毒性仅为二维剂量法观察到的一半。放疗与手术联合治疗毒性大于明确放疗。对于晚期肿瘤患者，有必要在不提高毒性的前提下提高靶体积的覆盖范围。2012爱思唯尔爱尔兰有限公司版权所有。放射治疗与肿瘤杂志（2012）：305-313
Purpose: In 2005 a French multicentric non randomized prospective study was initiated to compare two groups of patients treated for cervix carcinoma according to brachytherapy (BT) method: 2D vs 3D dosimetry. The BT dosimetric planning method was chosen for each patient in each center according to the availability of the technique. This study describes the results for 705 out of 801 patients available for analysis.Patients and methods: For the 2D arm, dosimetry was planned on orthogonal X-Rays using low dose rate (LDR) or pulsed dose rate (PDR) BT. For the 3D arm, dosimetry was planned on 3D imaging (mainly CT) and performed with PDR BT. Each center could follow the dosimetric method they were used to, according to the chosen radioelement and applicator. Manual or graphical optimization was allowed.Patients and methods: Three treatment regimens were defined: Group 1: BT followed by surgery; 165 patients (2D arm: 76; 3D arm: 89); Group 2: EBRT (+chemotherapy), BT, then surgery; 305 patients (2D arm: 142; 3D arm: 163); Group 3: EBRT (+chemotherapy), then BT; 235 patients, (2D arm: 118; 3D arm: 117).Patients and methods: The DVH parameters for CTVs (High Risk CTV and Intermediate Risk CTV) and organs at risk (OARS) were computed as recommended by GYN GEC ESTRO guidelines. Total doses were converted to equivalent doses in 2 Gy fractions (EQD2). Side effects were prospectively assessed using the CTCAEv3.0.Results: The 2D and 3D arms were well balanced with regard to age, FIGO stage, histology, EBRT dose and chemotherapy. For each treatment regimen, BT doses and volumes were comparable between the 2D and 3D arms in terms of dose to point A. isodose 60 Gy volume, dose to ICRU rectal points, and TRAK.Results: Dosimetric data in the 3D arm showed that the dose delivered to 90% of the High Risk CTV (HR CTV 090) was respectively, 81.2 Gy(alpha/beta 10), 63.2 Gy(alpha/beta 10) and 73.1 Gy(alpha/beta 10) for groups 1, 2 and 3. The Intermediate Risk (IR) CTV D90 was respectively, 58.5 Gy(alpha/beta 10), 57.3 Gy(alpha/beta 10) and 61.7 Gy(alpha/beta 10) for groups 1,2 and 3. For the OARs, doses delivered to D2 cc ranged 60-70 Gy(alpha/beta 3) for the bladder, 33-61 Gy(alpha/beta 3) for the rectum, and 44-58 Gy(alpha/beta 3) for the sigmoid according to the regimen.Results: At 24 months, local relapse-free survival was 91.9% and 100% in group 1, 84.7% and 93% in group 2, 73.9% and 78.5% in group 3; grade 3-4 toxicity rate was 14.6% and 8.9% in group 1, 12.5% and 8.8% in group 2, and 22.7% and 2.6% in group 3 for 2D and 3D arm.Conclusion: This multicentric study has shown that 3D BT is feasible and safe in routine practice. It has improved local control with half the toxicity observed with 2D dosimetry. The combined treatment with radiotherapy and surgery was more toxic than definitive radiotherapy. For patients with advanced tumors, it is necessary to improve coverage of target volumes without raising toxicity. (C) 2012 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 103 (2012) 305-313