目的:本研究旨在探讨三维打印非共面模板(3D-PNCT)辅助计算机断层扫描(CT)引导的高剂量率间质近距离放射治疗(HDR-ISBT)治疗外照射后盆腔复发性宫颈癌的疗效和安全性。
方法:从2019年1月至2023年8月,45名符合条件的患者被纳入该前瞻性队列。所有患者均接受3D-PNCT辅助CT引导的HDR-ISBT,规定剂量为4-7Gy/分数,达到3-8分以上的高危临床目标体积(HR-CTV),用于治疗或姑息目的。主要终点是局部无进展生存期(LPFS)和肿瘤缓解率(TRR)。次要结局指标包括总生存期(OS),毒性,和症状解决。
结果:45例患者接受了261份3D-PNCT辅助的HDR-ISBT。29例患者有孤立的盆腔复发,16例患者同时出现盆腔外或远处复发。TRR为66.7%。2年和5年LPFS率分别为30.0%和25.7%,分别。中位OS为23.2个月,2年和5年OS率分别为49.5%和34.0%,分别。多变量分析表明鳞状细胞癌,根治性手术,无复发间隔≥12个月,肿瘤直径,盆腔复发类型,HR-CTVD90≥45Gy是影响LPFS的独立因素(均p<0.05)。D100≥21Gy,V100≥83%,V150≥45%与较好的LPFS相关(均p<0.05)。肿瘤直径和转移是OS的独立预测因素(均p<0.05)。疼痛缓解率为66.7%(10/15)。20.0%的患者出现3-4级毒性。
结论:3D-PNCT辅助的HDR-ISBT用于复发性宫颈癌的再照射被证明是根治性手术的有效和安全的替代方案。
OBJECTIVE: This study aimed to investigate the efficacy and safety of 3-dimensional printing noncoplanar template (3D-PNCT)-assisted computed tomography (CT)-guided high-dose-rate interstitial brachytherapy (HDR-ISBT) for reirradiation of pelvic recurrent cervical carcinoma after external beam radiotherapy.
METHODS: From January 2019 to August 2023, 45 eligible patients were enrolled in this prospective cohort. All patients underwent 3D-PNCT-assisted CT-guided HDR-ISBT with a prescribed dose of 4-7 Gy/fraction to the high-risk clinical target volume (HR-CTV) over 3-8 fractions, either for curative or palliative purposes. The primary endpoints were local progression-free survival (LPFS) and tumor response rate (TRR). The secondary outcome measures included overall survival (OS), toxicities, and symptom resolution.
RESULTS: Forty-five patients received 261 fractions of 3D-PNCT-assisted HDR-ISBT. Twenty-nine patients had isolated pelvic recurrence, and 16 patients had simultaneous extra-pelvic or distant recurrences. The TRR was 66.7%. The 2- and 5-year LPFS rates were 30.0% and 25.7%, respectively. The median OS was 23.2 months, and 2- and 5-year OS rates were 49.5% and 34.0%, respectively. The multivariate analysis indicated that squamous cell carcinoma, radical surgery, recurrence-free interval≥12 months, tumor diameter, pelvic recurrence type, and HR-CTV D90≥45 Gy were independent factors influencing LPFS (all p<0.05). D100≥21 Gy, V100≥83%, and V150≥45% were associated with better LPFS (all p<0.05). Tumor diameter and metastasis were independent predictive factors for OS (all p<0.05). The pain relief rate was 66.7% (10/15). Grade 3-4 toxicities occurred in 20.0% of patients.
CONCLUSIONS: 3D-PNCT-assisted HDR-ISBT for reirradiation of recurrent cervical cancer proved to be an effective and safe alternative to radical surgery.