目的:本研究旨在建立阴道癌的体积基础剂量与肿瘤局部控制之间的剂量-反应关系。包括原发性阴道癌和阴道复发性妇科恶性肿瘤。
方法:我们通过检索PubMed,WebofScience,和Cochrane图书馆数据库到2023年8月12日。使用基于体积的剂量与临床结果之间的probit模型进行回归分析。根据分层进行亚组分析:出版年份,国家,患者的纳入时间,先前放疗的患者,年龄,原发性或复发性,肿瘤大小,同步放化疗比例,剂量率,用于规划的图像模态,和间质比例。
结果:从18项研究中确定了879例阴道癌患者。其中,293例原发性阴道癌,573例复发性阴道癌,13例不详。probit模型显示了HR-CTV(或CTV)D90与2年和3年局部对照之间的显着关系,P值分别为0.013和0.014。对应于90%2年局部控制概率的D90为79.0GyEQD2,10(95%CI:75.3-96.6GyEQD2,10)。
结论:发现2年或3年局部控制对HR-CTV(或CTV)D90的显著依赖性。我们的研究结果鼓励通过基于方案的多中心临床试验进一步验证阴道癌根治性放疗的剂量-反应关系。
OBJECTIVE: This study aimed to establish the dose-response relationship between volume base dose and tumor local control for vaginal cancer, including primary vaginal cancer and recurrent gynecologic malignancies in the vagina.
METHODS: We identified studies that reported volume base dose and local control by searching the PubMed, the Web of Science, and the Cochrane Library Database through August 12, 2023. The regression analyses were performed using probit model between volume based dose versus clinical outcomes. Subgroup analyses were performed according to stratification: publication year, country, inclusion time of patients, patients with prior radiotherapy, age, primaries or recurrent, tumor size, concurrent chemoradiotherapy proportion, dose rate, image modality for planning, and interstitial proportion.
RESULTS: A total of 879 patients with vaginal cancer were identified from 18 studies. Among them, 293 cases were primary vaginal cancer, 573 cases were recurrent cancer in the vagina, and 13 cases were unknown. The probit model showed a significant relationship between the HR-CTV (or CTV) D90 versus the 2-year and 3-year local control, P values were 0.013 and 0.014, respectively. The D90 corresponding to probabilities of 90% 2-year local control were 79.0 GyEQD2,10 (95% CI: 75.3-96.6 GyEQD2,10).
CONCLUSIONS: A significant dependence of 2-year or 3-year local control on HR-CTV (or CTV) D90 was found. Our research findings encourage further validation of the dose-response relationship of radical radiotherapy for vaginal cancer through protocol based multicenter clinical trials.