Extended-field irradiation and intracavitary brachytherapy combined with cisplatin chemotherapy for cervical cancer with positive para-aortic or high common iliac lymph nodes: Results of ARM 1 of RTOG 0116
Extended-field irradiation and intracavitary brachytherapy combined with cisplatin chemotherapy for cervical cancer with positive para-aortic or high common iliac lymph nodes: Results of ARM 1 of RTOG 0116
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DOI：
10.1016/j.ijrobp.2007.01.026
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发表时间：
2007-07-15
影响因子：
7
通讯作者：
Greven, Kathy
中科院分区：
文献类型：
--
作者：
Small, William, Jr.;Winter, Kathryn;Greven, Kathy
目的：放射治疗肿瘤学组（RTOG） 0116试验旨在首先确定无氨磷汀方案（第1部分）的毒性率，然后测试氨磷汀降低化疗联合大范围放疗和近距离放疗（第2部分）毒性的能力。本文报告了第1部分的结果。方法和材料：入选的患者包括宫颈癌和常见髂或主动脉旁高度转移的患者。患者接受45 Gy （1.8 Gy/分）的扩大野放疗，腔内照射。最后的A点剂量是85戈瑞的LDR当量。允许使用HDR。腹主动脉旁淋巴结阳性和髂总淋巴结增高至54 ~ 59.4 Gy。顺铂（40mg /m(2)）在外束治疗期间每周给予一次，近距离治疗时给予一次。第一部分的主要终点是急性3/4级毒性，不包括3级白细胞减少。结果：2000年8月1日至2003年12月3日共纳入26例符合条件的患者。其中，21例有主动脉旁转移（15例也有高度髂髂受累），5例仅有高度髂髂受累。所有患者的中位随访时间为17.1个月（1.8-38.6个月），存活患者的中位随访时间为21.7个月（11.4-38.6个月）。急性3/4级毒性率（不包括3级白细胞减少）为81%。晚期314级毒性为40%。8名患者因并发症接受了手术。16例（62%）患者对局部和淋巴结疾病均有完全缓解。局部完全缓解率为92%，整体完全缓解率为62%，局部和主动脉旁淋巴结缓解率分别为60%和71%。估计18个月无病生存率和总生存率分别为46%和60%。结论：顺铂扩大野区和腔内照射治疗宫颈癌主动脉旁转移或常见髂骨高度转移具有明显的急性和晚期毒性。(C) 2007爱思唯尔公司
Purpose: The Radiation Therapy Oncolology Group (RTOG) 0116 trial was designed to test the ability of Amifostine to reduce the toxicity of combined chemotherapy with extended-field radiotherapy and brachytherapy (Part 2), after first determining the toxicity rate for the regimen without Amifostine (Part 1). This manuscript reports the results of Part 1.Methods and Materials: Eligibility included patients with cervical carcinoma and high common iliac or para-aortic metastasis. Patients received extended-field radiotherapy to 45 Gy (1.8 Gy/fraction) with intracavitary irradiation. The final point A dose was 85 Gy LDR equivalent. Use of HDR was allowed. The positive para-aortic and high common iliac nodes were boosted to 54 to 59.4 Gy. Cisplatin (40 mg/m(2)) was delivered weekly during external beam and once with brachytherapy. The primary endpoint of Part I was acute Grade 3/4 toxicity, excluding Grade 3 leukopenia.Results: A total of 26 eligible patients were entered between August 1, 2000, and Decemeber 3, 2003. Of these, 21 had para-aortic metastasis (15 also had high common iliac involvement), and 5 had high common iliac involvement only. The median follow-up was 17.1 months (range, 1.8-38.6 months) for all patients and 21.7 months (range, 11.4-38.6 months) for alive patients. The acute Grade 3/4 toxicity rate, excluding Grade 3 leukopenia was 81%. Late Grade 314 toxicity was 40%. Eight patients underwent surgery for complications. Sixteen (62%) patients had a complete response for both local and nodal disease. The complete local response was 92%, the complete overall nodal response rate was 62% and the regional and para-aortic nodal response rates were 60% and 71% respectively. Estimated disease-free and overall survival at 18 months are 46% and 60%.Conclusions: Extended field and intracavitary irradiation with cisplatin for para-aortic or high common iliac metastasis from cervical cancer is associated with significant acute and late toxicity. (C) 2007 Elsevier Inc.