PO47

Brachytherapy Pub Date : 2023-09-01 DOI:10.1016/j.brachy.2023.06.148

Magdalena Anna Stankiewicz

{"title":"PO47","authors":"Magdalena Anna Stankiewicz","doi":"10.1016/j.brachy.2023.06.148","DOIUrl":null,"url":null,"abstract":"Purpose High-dose-rate (HDR) brachytherapy is a vital part of treatment in patients with locally advanced cervical cancer. Current guidelines recommend the use of image-guided adaptive brachytherapy (IGABT). Several fractionation schedules are used in external beam radiotherapy (EBRT) and brachytherapy (BT). A retrospective analysis of patients treated with radio(chemo)therapy and HDR brachytherapy due to cervical cancer was conducted. We compared the efficacy of two fractionation schedules implemented in our department. Materials and Methods Schedule one (\"5x6 Gy\") consisted of five fractions of 6 Gy delivered within 2.5 weeks. In the majority of patients, the dose was prescribed to point A. Schedule two (\"4x7 Gy\") consisted of four fractions of 7 Gy delivered within two weeks. In all patients, the dose was prescribed to CTV. Local control (LC) and distant metastasis-free survival (DMFS) were calculated. The Kaplan-Meier estimator, log-rank and Mann-Whitney U test were used in statistical analysis. One hundred seventeen patients were included in this analysis. Median age was 57 years (range: 29 - 79). The disease stage was re-assessed according to FIGO 2018 classification. Forty-five percent of patients had FIGO IIIC1 disease, 29% - FIGO IIIB, 15% - FIGO IIB and 6% - FIGO IIIC2. The vast majority of patients (96%) had were diagnosed with planoepithelial carcinoma, 2,5% with cervical adenocarcinoma, one patient with clear cell carcinoma and one with serous carcinoma. The \"5x6 Gy\" fractionation was administered in 79% of patients. The median overall treatment time (OTT) was 58 days (range: 45 - 139 days). The median CTV D90 EQD2 sum of EBRT and BT was 89 Gy (range: 65 - 114 Gy). Results In the \"5x6 Gy\" subgroup, the follow-up was significantly longer (p=0.00006), CTV D90 EQD2 was significantly higher (p=0.0001), and OTT was significantly longer (p=0.02). No other significant differences were observed between the subgroups. They were well balanced in terms of patients' age (p=0.6), histopathological grade of the tumour (p=0.2) and FIGO stage (p=0.07). In the whole group, 5-year LC was 91%, 5-year regional nodal control was 86%, and 5-year DMFS was 80%. The comparison of the two fractionation schedules (\"5x6 Gy\" vs \"4x7 Gy\") revealed that higher CTV D90 EQD2 was not associated with better local or distant control. There were no differences in LC (p=0.79), regional nodal control (p=0.7) or DMFS (p=0.83) between the subgroups. However, better regional nodal control and longer DMFS were observed in patients with OTT≤60 days (p=0.035 and p=0.017, respectively). Conclusions Both fractionation schedules have similar efficacy. A shorter overall treatment time is associated with better regional nodal control and DMFS. However, a longer follow-up is needed to confirm these findings. High-dose-rate (HDR) brachytherapy is a vital part of treatment in patients with locally advanced cervical cancer. Current guidelines recommend the use of image-guided adaptive brachytherapy (IGABT). Several fractionation schedules are used in external beam radiotherapy (EBRT) and brachytherapy (BT). A retrospective analysis of patients treated with radio(chemo)therapy and HDR brachytherapy due to cervical cancer was conducted. We compared the efficacy of two fractionation schedules implemented in our department. Schedule one (\"5x6 Gy\") consisted of five fractions of 6 Gy delivered within 2.5 weeks. In the majority of patients, the dose was prescribed to point A. Schedule two (\"4x7 Gy\") consisted of four fractions of 7 Gy delivered within two weeks. In all patients, the dose was prescribed to CTV. Local control (LC) and distant metastasis-free survival (DMFS) were calculated. The Kaplan-Meier estimator, log-rank and Mann-Whitney U test were used in statistical analysis. One hundred seventeen patients were included in this analysis. Median age was 57 years (range: 29 - 79). The disease stage was re-assessed according to FIGO 2018 classification. Forty-five percent of patients had FIGO IIIC1 disease, 29% - FIGO IIIB, 15% - FIGO IIB and 6% - FIGO IIIC2. The vast majority of patients (96%) had were diagnosed with planoepithelial carcinoma, 2,5% with cervical adenocarcinoma, one patient with clear cell carcinoma and one with serous carcinoma. The \"5x6 Gy\" fractionation was administered in 79% of patients. The median overall treatment time (OTT) was 58 days (range: 45 - 139 days). The median CTV D90 EQD2 sum of EBRT and BT was 89 Gy (range: 65 - 114 Gy). In the \"5x6 Gy\" subgroup, the follow-up was significantly longer (p=0.00006), CTV D90 EQD2 was significantly higher (p=0.0001), and OTT was significantly longer (p=0.02). No other significant differences were observed between the subgroups. They were well balanced in terms of patients' age (p=0.6), histopathological grade of the tumour (p=0.2) and FIGO stage (p=0.07). In the whole group, 5-year LC was 91%, 5-year regional nodal control was 86%, and 5-year DMFS was 80%. The comparison of the two fractionation schedules (\"5x6 Gy\" vs \"4x7 Gy\") revealed that higher CTV D90 EQD2 was not associated with better local or distant control. There were no differences in LC (p=0.79), regional nodal control (p=0.7) or DMFS (p=0.83) between the subgroups. However, better regional nodal control and longer DMFS were observed in patients with OTT≤60 days (p=0.035 and p=0.017, respectively). Both fractionation schedules have similar efficacy. A shorter overall treatment time is associated with better regional nodal control and DMFS. However, a longer follow-up is needed to confirm these findings.","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":"59 1","pages":"0"},"PeriodicalIF":0.0000,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Brachytherapy","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1016/j.brachy.2023.06.148","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose High-dose-rate (HDR) brachytherapy is a vital part of treatment in patients with locally advanced cervical cancer. Current guidelines recommend the use of image-guided adaptive brachytherapy (IGABT). Several fractionation schedules are used in external beam radiotherapy (EBRT) and brachytherapy (BT). A retrospective analysis of patients treated with radio(chemo)therapy and HDR brachytherapy due to cervical cancer was conducted. We compared the efficacy of two fractionation schedules implemented in our department. Materials and Methods Schedule one ("5x6 Gy") consisted of five fractions of 6 Gy delivered within 2.5 weeks. In the majority of patients, the dose was prescribed to point A. Schedule two ("4x7 Gy") consisted of four fractions of 7 Gy delivered within two weeks. In all patients, the dose was prescribed to CTV. Local control (LC) and distant metastasis-free survival (DMFS) were calculated. The Kaplan-Meier estimator, log-rank and Mann-Whitney U test were used in statistical analysis. One hundred seventeen patients were included in this analysis. Median age was 57 years (range: 29 - 79). The disease stage was re-assessed according to FIGO 2018 classification. Forty-five percent of patients had FIGO IIIC1 disease, 29% - FIGO IIIB, 15% - FIGO IIB and 6% - FIGO IIIC2. The vast majority of patients (96%) had were diagnosed with planoepithelial carcinoma, 2,5% with cervical adenocarcinoma, one patient with clear cell carcinoma and one with serous carcinoma. The "5x6 Gy" fractionation was administered in 79% of patients. The median overall treatment time (OTT) was 58 days (range: 45 - 139 days). The median CTV D90 EQD2 sum of EBRT and BT was 89 Gy (range: 65 - 114 Gy). Results In the "5x6 Gy" subgroup, the follow-up was significantly longer (p=0.00006), CTV D90 EQD2 was significantly higher (p=0.0001), and OTT was significantly longer (p=0.02). No other significant differences were observed between the subgroups. They were well balanced in terms of patients' age (p=0.6), histopathological grade of the tumour (p=0.2) and FIGO stage (p=0.07). In the whole group, 5-year LC was 91%, 5-year regional nodal control was 86%, and 5-year DMFS was 80%. The comparison of the two fractionation schedules ("5x6 Gy" vs "4x7 Gy") revealed that higher CTV D90 EQD2 was not associated with better local or distant control. There were no differences in LC (p=0.79), regional nodal control (p=0.7) or DMFS (p=0.83) between the subgroups. However, better regional nodal control and longer DMFS were observed in patients with OTT≤60 days (p=0.035 and p=0.017, respectively). Conclusions Both fractionation schedules have similar efficacy. A shorter overall treatment time is associated with better regional nodal control and DMFS. However, a longer follow-up is needed to confirm these findings. High-dose-rate (HDR) brachytherapy is a vital part of treatment in patients with locally advanced cervical cancer. Current guidelines recommend the use of image-guided adaptive brachytherapy (IGABT). Several fractionation schedules are used in external beam radiotherapy (EBRT) and brachytherapy (BT). A retrospective analysis of patients treated with radio(chemo)therapy and HDR brachytherapy due to cervical cancer was conducted. We compared the efficacy of two fractionation schedules implemented in our department. Schedule one ("5x6 Gy") consisted of five fractions of 6 Gy delivered within 2.5 weeks. In the majority of patients, the dose was prescribed to point A. Schedule two ("4x7 Gy") consisted of four fractions of 7 Gy delivered within two weeks. In all patients, the dose was prescribed to CTV. Local control (LC) and distant metastasis-free survival (DMFS) were calculated. The Kaplan-Meier estimator, log-rank and Mann-Whitney U test were used in statistical analysis. One hundred seventeen patients were included in this analysis. Median age was 57 years (range: 29 - 79). The disease stage was re-assessed according to FIGO 2018 classification. Forty-five percent of patients had FIGO IIIC1 disease, 29% - FIGO IIIB, 15% - FIGO IIB and 6% - FIGO IIIC2. The vast majority of patients (96%) had were diagnosed with planoepithelial carcinoma, 2,5% with cervical adenocarcinoma, one patient with clear cell carcinoma and one with serous carcinoma. The "5x6 Gy" fractionation was administered in 79% of patients. The median overall treatment time (OTT) was 58 days (range: 45 - 139 days). The median CTV D90 EQD2 sum of EBRT and BT was 89 Gy (range: 65 - 114 Gy). In the "5x6 Gy" subgroup, the follow-up was significantly longer (p=0.00006), CTV D90 EQD2 was significantly higher (p=0.0001), and OTT was significantly longer (p=0.02). No other significant differences were observed between the subgroups. They were well balanced in terms of patients' age (p=0.6), histopathological grade of the tumour (p=0.2) and FIGO stage (p=0.07). In the whole group, 5-year LC was 91%, 5-year regional nodal control was 86%, and 5-year DMFS was 80%. The comparison of the two fractionation schedules ("5x6 Gy" vs "4x7 Gy") revealed that higher CTV D90 EQD2 was not associated with better local or distant control. There were no differences in LC (p=0.79), regional nodal control (p=0.7) or DMFS (p=0.83) between the subgroups. However, better regional nodal control and longer DMFS were observed in patients with OTT≤60 days (p=0.035 and p=0.017, respectively). Both fractionation schedules have similar efficacy. A shorter overall treatment time is associated with better regional nodal control and DMFS. However, a longer follow-up is needed to confirm these findings.

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PO47

目的高剂量率(HDR)近距离放射治疗是局部晚期宫颈癌治疗的重要组成部分。目前的指南推荐使用图像引导的适应性近距离放射治疗(IGABT)。在体外放射治疗(EBRT)和近距离放射治疗(BT)中使用了几种分割方案。回顾性分析宫颈癌患者行放化疗和近距离放射治疗的病例。我们比较了两种分馏方案在我科实施的效果。方案一(“5x6 Gy”)包括在2.5周内递送的5份6gy。在大多数患者中，剂量被规定为a点。方案二(“4x7 Gy”)由在两周内给药的7 Gy的四个部分组成。在所有患者中，剂量都是给CTV开的。计算局部控制(LC)和远端无转移生存(DMFS)。统计分析采用Kaplan-Meier估计、log-rank和Mann-Whitney U检验。117名患者被纳入本分析。中位年龄为57岁(范围:29 - 79)。根据FIGO 2018分类重新评估疾病分期。45%的患者为FIGO IIIC1型，29%为FIGO IIIB型，15%为FIGO IIIB型，6%为FIGO IIIC2型。绝大多数患者(96%)被诊断为扁平上皮癌，2.5%被诊断为宫颈腺癌，1例被诊断为透明细胞癌，1例被诊断为浆液性癌。79%的患者接受“5x6 Gy”分离治疗。中位总治疗时间(OTT)为58天(范围:45 - 139天)。EBRT和BT的中位CTV D90 EQD2总和为89 Gy(范围:65 - 114 Gy)。结果“5x6 Gy”亚组随访时间显著延长(p=0.00006)， CTV D90 EQD2显著升高(p=0.0001)， OTT显著延长(p=0.02)。亚组间未观察到其他显著差异。他们在患者的年龄(p=0.6)、肿瘤的组织病理分级(p=0.2)和FIGO分期(p=0.07)方面平衡良好。全组5年LC为91%，5年区域淋巴结控制率为86%，5年DMFS为80%。两种分选方案(“5x6 Gy”和“4x7 Gy”)的比较显示，较高的CTV D90 EQD2与较好的局部或远程控制无关。亚组间LC (p=0.79)、区域淋巴结控制(p=0.7)和DMFS (p=0.83)均无差异。然而，OTT≤60天的患者区域淋巴结控制较好，DMFS较长(p=0.035和p=0.017)。结论两种提取方案疗效相近。较短的总治疗时间与较好的局部淋巴结控制和DMFS相关。然而，需要更长的随访来证实这些发现。高剂量率(HDR)近距离放疗是局部晚期宫颈癌患者治疗的重要组成部分。目前的指南推荐使用图像引导的适应性近距离放射治疗(IGABT)。在体外放射治疗(EBRT)和近距离放射治疗(BT)中使用了几种分割方案。回顾性分析宫颈癌患者行放化疗和近距离放射治疗的病例。我们比较了两种分馏方案在我科实施的效果。方案一(“5x6 Gy”)由2.5周内交付的6 Gy的五个部分组成。在大多数患者中，剂量被规定为a点。方案二(“4x7 Gy”)由在两周内给药的7 Gy的四个部分组成。在所有患者中，剂量都是给CTV开的。计算局部控制(LC)和远端无转移生存(DMFS)。统计分析采用Kaplan-Meier估计、log-rank和Mann-Whitney U检验。117名患者被纳入本分析。中位年龄为57岁(范围:29 - 79)。根据FIGO 2018分类重新评估疾病分期。45%的患者为FIGO IIIC1型，29%为FIGO IIIB型，15%为FIGO IIIB型，6%为FIGO IIIC2型。绝大多数患者(96%)被诊断为扁平上皮癌，2.5%被诊断为宫颈腺癌，1例被诊断为透明细胞癌，1例被诊断为浆液性癌。79%的患者接受“5x6 Gy”分离治疗。中位总治疗时间(OTT)为58天(范围:45 - 139天)。EBRT和BT的中位CTV D90 EQD2总和为89 Gy(范围:65 - 114 Gy)。“5x6 Gy”亚组随访时间显著延长(p=0.00006)， CTV D90 EQD2显著增高(p=0.0001)， OTT显著延长(p=0.02)。亚组间未观察到其他显著差异。他们在患者的年龄(p=0.6)、肿瘤的组织病理分级(p=0.2)和FIGO分期(p=0.07)方面平衡良好。全组5年LC为91%，5年区域淋巴结控制率为86%，5年DMFS为80%。目的高剂量率(HDR)近距离放射治疗是局部晚期宫颈癌治疗的重要组成部分。目前的指南推荐使用图像引导的适应性近距离放射治疗(IGABT)。在体外放射治疗(EBRT)和近距离放射治疗(BT)中使用了几种分割方案。回顾性分析宫颈癌患者行放化疗和近距离放射治疗的病例。我们比较了两种分馏方案在我科实施的效果。方案一(“5x6 Gy”)包括在2.5周内递送的5份6gy。在大多数患者中，剂量被规定为a点。方案二(“4x7 Gy”)由在两周内给药的7 Gy的四个部分组成。在所有患者中，剂量都是给CTV开的。计算局部控制(LC)和远端无转移生存(DMFS)。统计分析采用Kaplan-Meier估计、log-rank和Mann-Whitney U检验。117名患者被纳入本分析。中位年龄为57岁(范围:29 - 79)。根据FIGO 2018分类重新评估疾病分期。45%的患者为FIGO IIIC1型，29%为FIGO IIIB型，15%为FIGO IIIB型，6%为FIGO IIIC2型。绝大多数患者(96%)被诊断为扁平上皮癌，2.5%被诊断为宫颈腺癌，1例被诊断为透明细胞癌，1例被诊断为浆液性癌。79%的患者接受“5x6 Gy”分离治疗。中位总治疗时间(OTT)为58天(范围:45 - 139天)。EBRT和BT的中位CTV D90 EQD2总和为89 Gy(范围:65 - 114 Gy)。结果“5x6 Gy”亚组随访时间显著延长(p=0.00006)， CTV D90 EQD2显著升高(p=0.0001)， OTT显著延长(p=0.02)。亚组间未观察到其他显著差异。他们在患者的年龄(p=0.6)、肿瘤的组织病理分级(p=0.2)和FIGO分期(p=0.07)方面平衡良好。全组5年LC为91%，5年区域淋巴结控制率为86%，5年DMFS为80%。两种分选方案(“5x6 Gy”和“4x7 Gy”)的比较显示，较高的CTV D90 EQD2与较好的局部或远程控制无关。亚组间LC (p=0.79)、区域淋巴结控制(p=0.7)和DMFS (p=0.83)均无差异。然而，OTT≤60天的患者区域淋巴结控制较好，DMFS较长(p=0.035和p=0.017)。结论两种提取方案疗效相近。较短的总治疗时间与较好的局部淋巴结控制和DMFS相关。然而，需要更长的随访来证实这些发现。高剂量率(HDR)近距离放疗是局部晚期宫颈癌患者治疗的重要组成部分。目前的指南推荐使用图像引导的适应性近距离放射治疗(IGABT)。在体外放射治疗(EBRT)和近距离放射治疗(BT)中使用了几种分割方案。回顾性分析宫颈癌患者行放化疗和近距离放射治疗的病例。我们比较了两种分馏方案在我科实施的效果。方案一(“5x6 Gy”)由2.5周内交付的6 Gy的五个部分组成。在大多数患者中，剂量被规定为a点。方案二(“4x7 Gy”)由在两周内给药的7 Gy的四个部分组成。在所有患者中，剂量都是给CTV开的。计算局部控制(LC)和远端无转移生存(DMFS)。统计分析采用Kaplan-Meier估计、log-rank和Mann-Whitney U检验。117名患者被纳入本分析。中位年龄为57岁(范围:29 - 79)。根据FIGO 2018分类重新评估疾病分期。45%的患者为FIGO IIIC1型，29%为FIGO IIIB型，15%为FIGO IIIB型，6%为FIGO IIIC2型。绝大多数患者(96%)被诊断为扁平上皮癌，2.5%被诊断为宫颈腺癌，1例被诊断为透明细胞癌，1例被诊断为浆液性癌。79%的患者接受“5x6 Gy”分离治疗。中位总治疗时间(OTT)为58天(范围:45 - 139天)。EBRT和BT的中位CTV D90 EQD2总和为89 Gy(范围:65 - 114 Gy)。“5x6 Gy”亚组随访时间显著延长(p=0.00006)， CTV D90 EQD2显著增高(p=0.0001)， OTT显著延长(p=0.02)。亚组间未观察到其他显著差异。他们在患者的年龄(p=0.6)、肿瘤的组织病理分级(p=0.2)和FIGO分期(p=0.07)方面平衡良好。全组5年LC为91%，5年区域淋巴结控制率为86%，5年DMFS为80%。两种分选方案(“5x6 Gy”和“4x7 Gy”)的比较显示，较高的CTV D90 EQD2与较好的局部或远程控制无关。亚组间LC (p=0.79)、区域淋巴结控制(p=0.7)和DMFS (p=0.83)均无差异。然而，OTT≤60天的患者区域淋巴结控制较好，DMFS较长(p=0.035和p=0.017)。两种分馏方案的效果相似。较短的总治疗时间与较好的局部淋巴结控制和DMFS相关。然而，需要更长的随访来证实这些发现。两种分选方案(“5x6 Gy”和“4x7 Gy”)的比较显示，较高的CTV D90 EQD2与较好的局部或远程控制无关。亚组间LC (p=0.79)、区域淋巴结控制(p=0.7)和DMFS (p=0.83)均无差异。然而，OTT≤60天的患者区域淋巴结控制较好，DMFS较长(p=0.035和p=0.017)。两种分馏方案的效果相似。较短的总治疗时间与较好的局部淋巴结控制和DMFS相关。然而，需要更长的随访来证实这些发现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Brachytherapy

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