Evaluation of planning aims and dose prescription in image-guided adaptive brachytherapy and radiochemotherapy for cervical cancer: Vienna clinical experience in 225 patients from 1998 to 2008
Evaluation of planning aims and dose prescription in image-guided adaptive brachytherapy and radiochemotherapy for cervical cancer: Vienna clinical experience in 225 patients from 1998 to 2008
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DOI：
10.3109/0284186x.2015.1063783
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发表时间：
2015-10-21
期刊：
影响因子：
3.1
通讯作者：
Schmid, Maximilian P.
中科院分区：
文献类型：
--
作者：
Majercakova, Katarina;Poetter, Richard;Schmid, Maximilian P.
背景资料。目的：评价宫颈癌影像引导自适应近距离放射治疗(IGABT)的计划目标(PAS)和剂量处方，并探讨其对临床结果的潜在影响。我们的研究人群包括1998年至2008年在维也纳医科大学接受体外放射治疗(EBRT)、化疗和IGABT治疗的225名连续的宫颈癌患者(FIGO分期IB-IVA)。在这项回顾性研究中，患者被分成两个处理组：PA+组，满足处方的所有剂量约束；PA-，一个或多个未满足处方的剂量约束。剂量限制(EBRT+IGABT)：临床靶区体积(CTV)(HR)D-90~85GY，直肠D-2cm~3+Lt；70GY，D-2Cm~3膀胱+LT；90GY。比较两组在患者、肿瘤、治疗特点和临床结局(事件：局部失败或3+4级毒性)方面的差异，并分析学习周期(1998-2000)和方案周期(2001-2008)对PAS剂量处方和临床结果履行情况的影响。PA+组77例(34%)，PA-组148例(66%)。PA组82例给予CTVHR D-90+Gt；85Gy，80例给予D-2cm~3膀胱+Gt；90Gy，60例给予D-2cm~3直肠+Gt；70Gy。PA对剂量处方的满足率从学习期的4%提高到协议期的48%。5年无事件间隔在学习期间为%，在治疗期间为84%(p=0.008)。完成所有PA的剂量处方是具有挑战性的-特别是在更晚期的肿瘤患者。然而，随着经验的增长，PA对剂量处方的实施率可以显著增加(学习和协议期)。在履行PA剂量处方方面的这种增加紧随着临床结果的显著改善。
Background. To assess planning aims (PAs) and dose prescription in image-guided adaptive brachytherapy (IGABT) of cervical cancer and investigate potential impact on clinical outcome.Material and methods. Our study population consists of 225 consecutive cervical cancer patients (FIGO stages IB-IVA) treated between 1998 and 2008 at the Medical University of Vienna by external beam radiotherapy (EBRT) chemotherapy and IGABT. For this retrospective study, patients were stratified into two treatment groups: PA+ group, all dose constraints fulfilled for prescription; PA-, one or more dose constraints not fulfilled for prescription. The following dose constraints (EBRT+ IGABT) were applied: clinical target volume (CTV)(HR) D-90 85 Gy, D-2cm3 Rectum < 70 Gy, D-2cm3 Bladder < 90 Gy. Differences in patient, tumor and treatment characteristics and clinical outcome (event: local failure or grade 3 + 4 toxicity) were compared between Group 1 and 2. Further, the impact of learning period (1998-2000) and protocol period (2001-2008) on the fulfillment of PAs for dose prescription and clinical outcome was analyzed.Results. In the PA+ group there were 77 (34%) and in the PA- group 148 (66%) patients. In the PA- group, CTVHR D-90 < 85 Gy was prescribed in 82 patients, D-2cm3 bladder > 90 Gy was prescribed in 80 patients and D-2cm3 Rectum > 70 Gy in 60 patients. Fulfillment of the PA for dose prescription improved from 4% in the learning period to 48% in the protocol period. The five-year event-free interval was 64% in the learning period and 84% in the protocol period (p = 0.008).Conclusion. Fulfillment of all PAs for dose prescription is challenging - especially in patients with more advanced tumors. However, with growing experience fulfillment of PA for dose prescription can be significantly increased (learning and protocol period). Such increase in fulfilling PA for dose prescription is followed by a significant improvement in clinical outcome.