■放疗(RCT)后增强近距离放射治疗(BT)是治疗局部晚期宫颈癌(LACC)的标准护理。由于高剂量率(HDR)BT分级分离方案没有共识,我们的目的是报告使用每日2次(BID)HDR-BT的4种不同方案的肿瘤结局和毒性特征.
■这是一个观察,回顾性,接受HDR-BT增强的LACC患者的单机构研究。后者是在第1天用单个植入物和单个成像进行的。不同的分级分离方案是:7Gy+4x3.5Gy(组1);7Gy+4x4.5Gy(组2);3x7Gy(组3)和3x8Gy(组4)。本地(LFS),分析淋巴结(NFS)和转移(MFS)无复发生存期以及无进展生存期(PFS)和总生存期(OS).报告急性(≤6个月)和晚期毒性(>6个月)。
■从2007年到2018年,共纳入191例患者。中位随访时间为57个月[45-132],第2、3和4组的中位EQD210D90CTVHR分别为84、82和90Gy(第1组缺少剂量学数据)。五年LFS,NFS,MFS,PFS和OS为85%[81-90],83%[79-86],70%[67-73],分别为61%[57-64]和75%[69-78],组间无显著差异。单因素分析中EQD210D90CTVHR<85Gy是局部复发的预后因素(p=0.045)。急性/晚期≥2级泌尿的发生率,消化和妇科毒性为9%/15%,分别为3%/15%和9%/25%。
■双重分级的HDR-BT增强似乎是可行的,具有良好的肿瘤学结果,并且在剂量增加后毒性稍高。
OBJECTIVE: Brachytherapy (BT) boost after radio-chemotherapy (RCT) is a standard of care in the management of locally advanced cervical cancer (LACC). As there is no consensus on high-dose-rate (HDR) BT fractionation schemes, our aim was to report the oncological outcome and toxicity profile of four different schemes using twice-a-day (BID) HDR-BT.
METHODS: This was an observational, retrospective, single institution study for patients with LACC receiving a HDR-BT boost. The latter was performed with a single implant and single imaging done on day 1. The different fractionation schemes were: 7 Gy + 4x3.5 Gy (group 1); 7 Gy + 4x4.5 Gy (group 2); 3x7Gy (group 3) and 3x8Gy (group 4). Local (LFS), nodal (NFS) and metastatic (MFS) recurrence-free survival as well as progression-free survival (PFS) and overall survival (OS) were analyzed. Acute (≤6 months) and late toxicities (>6 months) were reported.
RESULTS: From 2007 to 2018, 191 patients were included. Median follow-up was 57 months [45-132] and median EQD210D90CTVHR was 84, 82 and 90 Gy for groups 2, 3 and 4 respectively (dosimetric data missing for group 1). The 5-year LFS, NFS, MFS, PFS and OS were 85% [81-90], 83% [79-86], 70% [67-73], 61% [57-64] and 75% [69-78] respectively, with no significant difference between the groups. EQD210D90CTVHR < 85 Gy was a prognostic factor for local recurrence in univariate analysis (p = 0.045). The rates of acute/late grade ≥ 2 urinary, digestive and gynecological toxicities were 9%/15%, 3%/15% and 9%/25% respectively.
CONCLUSIONS: Bi-fractionated HDR-BT boost seems feasible with good oncological outcome and slightly more toxicity after dose escalation.