18F-fluorodeoxyglucose PET-CT-guided pelvic chemoradiation therapy using helical tomotherapy for locally advanced carcinoma cervix without para-aortic nodal disease: Clinical and patient-reported outcomes from a prospective phase 2 study

IF 2.2 4区 医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Rimpa Basu Achari, Santam Chakraborty, Soumendranath Ray, Anurupa Mahata, Samar Mandal, Jayanta Das, Kanishka Sarkar, Indranil Mallick, Jaydip Bhaumik, Basumita Chakraborti, Anik Ghosh, Saugata Sen, Aditi Chandra, Sanjoy Chatterjee, Moses Arunsingh, Tapesh Bhattacharyya
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引用次数: 0

Abstract

Introduction

Locally advanced carcinoma cervix (LACC) is a heterogeneous disease with variable combinations of primary tumour extensions with or without nodal involvement. Metabolic information from 18 fluro-deoxyglucose positron emission tomography combined with contrast-enhanced computerized tomography (FDG PET-CT) may potentially augment treatment decision-making for LACC. This study ascertained FDG-PET CT influence on chemoradiation therapy (CTRT) decisions in LACC. We report oncologic and patient-reported outcome measures (PROMs).

Methods

FDG PET-CT scans were reviewed independently by two nuclear medicine specialists and two radiation oncologists. Pelvic CTRT plan digressions were documented and therapy was adapted accordingly. Pelvis radiation (50 Gy/25#/5 weeks) using tomotherapy with weekly cisplatin was used in node-negative disease. Dose-escalated simultaneous integrated boost (SIB) 60 Gy/25#/5 weeks was delivered to involved pelvic nodes. All received brachytherapy. Post-treatment PET-CT scans were at 6 months. Functional assessment of cancer therapy scores were calculated at baseline, treatment completion, 3 months, 1 year and 3 years.

Results

Between November 2015 and January 2018, 85 patients were screened, and 77 consented. Extrapelvic disease was seen in 12 (16%) patients (9 para-aortic nodes, 2 distant metastases and 1 synchronous carcinoma breast); 60 patients were included in the final analysis. Decision changes were seen in 10/77 (13%) screened, 8/60 (13%) included and 32 (53.3%) received SIB. Post-treatment, 27 (45%) had grade 2 GI/GU/GYN toxicity, one (2%) had grade 3 GI and five (8.3%) had grade 3 neutropenia. At median follow-up of 54.2 months (95% CI 52.8–58.3), 5-year local failure, pelvic nodal and para-aortic nodal-free survival were 86.8% (95% CI 78.0–96.6), 85.2% (95% CI 76.1–95.3) and 85.2% (95% CI 76.2–95.4). Functional assessment of cancer therapy trial outcome index (FACT TOI) improved by 10.43 at 3 months with no further decline. Grade 3 toxicity was noted for abdominal pain in one (1.7%), cystitis in four (6.7%) and lymphoedema in one (1.7%) at 5 years.

Conclusion

PET-CT resulted in major decision changes in 13%. PET-adapted CTRT was associated with acceptable toxicity, encouraging long-term survival and improvement in PROMS.

对无主动脉旁结节病的局部晚期宫颈癌采用螺旋断层疗法进行 18F 氟脱氧葡萄糖 PET-CT 引导的盆腔化疗:一项前瞻性 2 期研究的临床和患者报告结果。
导言:局部晚期宫颈癌(LACC)是一种异质性疾病,其原发肿瘤扩展的组合各不相同,有的有结节累及,有的没有结节累及。18 氟脱氧葡萄糖正电子发射计算机断层扫描(18 fluro-deoxyglucose positron emission tomography)结合对比增强计算机断层扫描(18 fluro-deoxyglucose positron emission tomography combined with contrast-enhanced computerized tomography,FDG PET-CT)所提供的代谢信息有可能增强宫颈癌的治疗决策。本研究确定了 FDG-PET CT 对 LACC 化疗 (CTRT) 决策的影响。我们报告了肿瘤学和患者报告的结果测量(PROMs):方法:两名核医学专家和两名放射肿瘤专家对 FDG PET-CT 扫描进行独立审查。记录骨盆 CTRT 计划偏离情况,并相应调整治疗方案。在结节阴性疾病中,使用断层疗法和每周顺铂进行盆腔放疗(50 Gy/25#/5周)。对受累的盆腔结节采用剂量递增的同步综合增强疗法(SIB),剂量为60 Gy/25#/5周。所有患者都接受了近距离放射治疗。治疗后 PET-CT 扫描时间为 6 个月。在基线、治疗结束、3个月、1年和3年时计算癌症治疗功能评估得分:2015年11月至2018年1月期间,85名患者接受了筛查,77人同意接受治疗。12例(16%)患者出现盆腔外疾病(9例主动脉旁结节、2例远处转移和1例同步癌乳腺癌);60例患者纳入最终分析。10/77(13%)名筛查患者出现了决策改变,8/60(13%)名患者接受了 SIB 治疗,32(53.3%)名患者接受了 SIB 治疗。治疗后,27 例(45%)患者出现 2 级消化道/急诊科/妇产科毒性,1 例(2%)患者出现 3 级消化道毒性,5 例(8.3%)患者出现 3 级中性粒细胞减少。中位总生存期为54.2个月(95% CI 52.8-58.3),5年局部失败、盆腔结节和主动脉旁无结节生存期分别为86.8%(95% CI 78.0-96.6)、85.2%(95% CI 76.1-95.3)和85.2%(95% CI 76.2-95.4)。癌症治疗试验结果功能评估指数(FACT TOI)在3个月时提高了10.43,且没有进一步下降。5年后发现的3级毒性为腹痛1例(1.7%)、膀胱炎4例(6.7%)和淋巴水肿1例(1.7%):结论:PET-CT导致13%的患者做出重大决定。与 PET 相适应的 CTRT 具有可接受的毒性、令人鼓舞的长期生存率和 PROMS 的改善。
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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来源期刊
CiteScore
3.30
自引率
6.20%
发文量
133
审稿时长
6-12 weeks
期刊介绍: Journal of Medical Imaging and Radiation Oncology (formerly Australasian Radiology) is the official journal of The Royal Australian and New Zealand College of Radiologists, publishing articles of scientific excellence in radiology and radiation oncology. Manuscripts are judged on the basis of their contribution of original data and ideas or interpretation. All articles are peer reviewed.
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