Image-guided adaptive brachytherapy in cervical cancer: Patterns of relapse by brachytherapy planning parameters
Image-guided adaptive brachytherapy in cervical cancer: Patterns of relapse by brachytherapy planning parameters
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DOI：
10.1016/j.brachy.2016.04.006
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发表时间：
2016-07-01
期刊：
影响因子：
1.9
通讯作者：
Haie-Meder, Christine
中科院分区：
文献类型：
--
作者：
Chargari, Cyrus;Mazeron, Renaud;Haie-Meder, Christine
目得：在局部控制方面，具有庞大的高风险临床靶体积（HR-CTV）的宫颈癌患者获得剂量递增的最大益处。然而，较高的转移风险可能会降低预期的生存获益。我们研究了复发的模式，根据主要的预后因素：HR-CTV体积和D-90 HR-CTV.METHODS和MATERIALS：脉冲剂量率图像引导自适应近距离放射治疗后，并行盆腔放化疗的患者的临床记录进行了审查。所有患者在治疗前均接受了最佳检查，包括18-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描和主动脉旁淋巴结清扫。结果：共109例患者符合纳入标准。中位随访时间为39个月。HR-CTV体积>= 40 cm（3）与局部无失败生存率较差相关。HR-CTV体积与HR-CTV的D-90之间存在强的负相关性（相关系数r = -0.696; p < 0.001），其中增加的HR-CTV体积与降低的D-90 HR-CTV相关。D-90 HR-CTV = 40 cm（3）是经历非局部失败的显著单变量因素（分别为p = 0.002和0.035），即使排除局部复发后也是如此。结论：达到目标D-90 HR-CTV计划的能力较低和HR-CTV体积> 40 cm（3）与远距离复发的高倾向相关，这些因素相互关联。个性化治疗的下一步应该设计整合这种风险的策略，这是目前失败的主要原因。(C)2016年美国近距离放射治疗协会。爱思唯尔公司出版All rights reserved.
PURPOSE: Cervical cancer patients with a bulky high-risk clinical target volume (HR-CTV) get the largest benefit of dose escalation in terms of local control. However, the expected survival benefit could be lessened by a higher metastatic risk. We examined the patterns of relapse according to major prognostic factors: the HR-CTV volume and to the D-90 HR-CTV.METHODS AND MATERIALS: The clinical records of patients treated with pulsed-dose-rate image-guided adaptive brachytherapy after concurrent pelvic chemoradiation were reviewed. All patients had an optimal workup before treatment comprising a 18-fluorodeoxyglucose positron emission tomography/computed tomography and a para-aortic lymph node dissection. Patients with initial extrapelvic disease were excluded.RESULTS: A total of 109 patients fulfilled inclusion criteria. Median followup was 39 months. An HR-CTV volume >= 40 cm(3) was associated with a poorer local failure-free survival. There was a strong inverse correlation between the HR-CTV volume and the D-90 of the HR-CTV (correlation coefficient r = -0.696; p < 0.001) with increasing HR-CTV volume being associated with a decreasing D-90 HR-CTV. A D-90 HR-CTV = 40 cm(3) were significant univariate factors for experiencing nonlocal failure (p = 0.002 and 0.035, respectively), even after exclusion of local relapses.CONCLUSION: A lower ability to reach the target D-90 HR-CTV planning and an HR-CTV volume > 40 cm(3) correlated with a high propensity of relapsing at distance, these factors being interrelated. Next step of treatment personalization should design strategies integrating this risk, which is now the main cause of failure. (C) 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.