PDF(Pubmed)
Abstract：
BACKGROUND: Volumetric modulated arc therapy (VMAT) is a novel form of IMRT, which can deliver more accurate dose distribution and shorten treatment time. Compared to MRI-guided adaptive brachytherapy, which is recommended as gold standard imaging for cervical cancer contours, CT-guided adaptive brachytherapy (CTGAB) is more available, more widespread, and more affordable in many centers. This study aims to retrospectively analyze the efficacy and the safety of VMAT combined with CTGAB for patients with locally advanced cervical cancer.
METHODS: This study retrospectively analyzed 102 patients with locally advanced cervical cancer who underwent VMAT and CTGAB. Clinical outcomes including local control (LC), overall survival (OS) and progression-free survival (PFS), tumor response to treatment evaluated by the Response Evaluation Criteria in Solid Tumors (RECIST) (version 1.1), and toxicities including gastrointestinal toxicity, urinary toxicity and hematologic toxicity evaluated by the Common Terminology Criteria for Adverse Events (CTCAE) (version 5.0) were analyzed. The Kaplan-Meier method was used to calculate LC, OS, and PFS.
RESULTS: Median follow-up time was 19 months. Complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD) occurred in 68 (66.7%), 24 (23.5%), 4 (3.92%), and 6 (5.88%), respectively. The 2-year and 3-year OS were 89.6% and 83%, respectively. The 2-year and 3-year PFS were 84.2% and 74.3%, respectively. The 2-year and 3-year LC were 90.1% and 79.3%, respectively. The average cumulative D2cm3 in the rectum, the bladder, the colon, and the small intestine were 78.07 (SD: 0.46) Gy, 93.20 (SD: 0.63) Gy, 63.55 (SD: 1.03) Gy and 61.07 (SD: 0.75) Gy, respectively. The average cumulative D90% of the high-risk clinical target volume (HR-CTV) was 92.26 (SD: 0.35) Gy. Grade ≥ 3 gastrointestinal and urinary toxicities occurred in 4.9% and 0.98%, respectively. 1.96% of patients were observed grade ≥ 4 gastrointestinal toxicities and none of the patients observed grade ≥ 4 urinary toxicities.
CONCLUSIONS: VMAT combined with CTGAB for locally advanced cervical cancer was an effective and safe treatment method, which showed satisfactory LC, OS, PFS, and acceptable toxicities.
METHODS: This study retrospectively analyzed 102 patients with locally advanced cervical cancer who underwent VMAT and CTGAB. Clinical outcomes including local control (LC), overall survival (OS) and progression-free survival (PFS), tumor response to treatment evaluated by the Response Evaluation Criteria in Solid Tumors (RECIST) (version 1.1), and toxicities including gastrointestinal toxicity, urinary toxicity and hematologic toxicity evaluated by the Common Terminology Criteria for Adverse Events (CTCAE) (version 5.0) were analyzed. The Kaplan-Meier method was used to calculate LC, OS, and PFS.
RESULTS: Median follow-up time was 19 months. Complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD) occurred in 68 (66.7%), 24 (23.5%), 4 (3.92%), and 6 (5.88%), respectively. The 2-year and 3-year OS were 89.6% and 83%, respectively. The 2-year and 3-year PFS were 84.2% and 74.3%, respectively. The 2-year and 3-year LC were 90.1% and 79.3%, respectively. The average cumulative D2cm3 in the rectum, the bladder, the colon, and the small intestine were 78.07 (SD: 0.46) Gy, 93.20 (SD: 0.63) Gy, 63.55 (SD: 1.03) Gy and 61.07 (SD: 0.75) Gy, respectively. The average cumulative D90% of the high-risk clinical target volume (HR-CTV) was 92.26 (SD: 0.35) Gy. Grade ≥ 3 gastrointestinal and urinary toxicities occurred in 4.9% and 0.98%, respectively. 1.96% of patients were observed grade ≥ 4 gastrointestinal toxicities and none of the patients observed grade ≥ 4 urinary toxicities.
CONCLUSIONS: VMAT combined with CTGAB for locally advanced cervical cancer was an effective and safe treatment method, which showed satisfactory LC, OS, PFS, and acceptable toxicities.
摘要：
背景：体积调制电弧疗法（VMAT）是IMRT的一种新型形式，可以提供更准确的剂量分布和缩短治疗时间。与MRI引导的自适应近距离放射治疗相比，这被推荐作为宫颈癌轮廓的金标准成像，CT引导的自适应近距离放射治疗（CTGAB）更可用，更广泛，在许多中心更实惠。本研究旨在回顾性分析VMAT联合CTGAB治疗局部晚期宫颈癌的疗效及安全性。
方法：本研究回顾性分析了102例接受VMAT和CTGAB治疗的局部晚期宫颈癌患者。临床结果包括局部控制（LC），总生存期（OS）和无进展生存期（PFS），通过实体瘤反应评估标准（RECIST）（1.1版）评估肿瘤对治疗的反应，和毒性，包括胃肠道毒性，分析了通过不良事件通用术语标准(CTCAE)(5.0版)评估的尿毒性和血液学毒性.Kaplan-Meier方法用于计算LC，操作系统,和PFS。
结果：中位随访时间为19个月。完全响应(CR),部分响应（PR），稳定的疾病（SD），进行性疾病(PD)发生在68例(66.7%)，24（23.5%），4（3.92%），和6（5.88%），分别。2年和3年OS分别为89.6%和83%，分别。2年和3年PFS分别为84.2%和74.3%,分别。2年和3年LC分别为90.1%和79.3%,分别。直肠中的平均累积D2cm3，膀胱，结肠，小肠为78.07(SD:0.46)Gy,93.20（标准差：0.63）Gy，63.55（SD：1.03）Gy和61.07（SD：0.75）Gy，分别。高危临床靶量(HR-CTV)的平均累积D90%为92.26(SD:0.35)Gy。4.9%和0.98%发生≥3级胃肠道和尿毒性，分别。1.96％的患者观察到≥4级胃肠道毒性，没有患者观察到≥4级尿毒性。
结论：VMAT联合CTGAB治疗局部晚期宫颈癌是一种安全有效的治疗方法。显示令人满意的LC，操作系统,PFS,和可接受的毒性。
方法：本研究回顾性分析了102例接受VMAT和CTGAB治疗的局部晚期宫颈癌患者。临床结果包括局部控制（LC），总生存期（OS）和无进展生存期（PFS），通过实体瘤反应评估标准（RECIST）（1.1版）评估肿瘤对治疗的反应，和毒性，包括胃肠道毒性，分析了通过不良事件通用术语标准(CTCAE)(5.0版)评估的尿毒性和血液学毒性.Kaplan-Meier方法用于计算LC，操作系统,和PFS。
结果：中位随访时间为19个月。完全响应(CR),部分响应（PR），稳定的疾病（SD），进行性疾病(PD)发生在68例(66.7%)，24（23.5%），4（3.92%），和6（5.88%），分别。2年和3年OS分别为89.6%和83%，分别。2年和3年PFS分别为84.2%和74.3%,分别。2年和3年LC分别为90.1%和79.3%,分别。直肠中的平均累积D2cm3，膀胱，结肠，小肠为78.07(SD:0.46)Gy,93.20（标准差：0.63）Gy，63.55（SD：1.03）Gy和61.07（SD：0.75）Gy，分别。高危临床靶量(HR-CTV)的平均累积D90%为92.26(SD:0.35)Gy。4.9%和0.98%发生≥3级胃肠道和尿毒性，分别。1.96％的患者观察到≥4级胃肠道毒性，没有患者观察到≥4级尿毒性。
结论：VMAT联合CTGAB治疗局部晚期宫颈癌是一种安全有效的治疗方法。显示令人满意的LC，操作系统,PFS,和可接受的毒性。
