GPP06 Presentation Time: 11:15 AM

IF 1.7 4区医学 Q4 ONCOLOGY

Brachytherapy Pub Date : 2024-10-25 DOI:10.1016/j.brachy.2024.08.092

Keara English MD, Michael Roumeliotis Ph.D., Tim Lin MD, Todd McNutt PhD, Mohammad Rezaee PhD, Junghoon Lee PhD, Akila Viswanathan MD, MPH

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HDR-BT was delivered via Syed interstitial template or multichannel cylinder. Pre-procedure, pts had MR (T1-, T2-, diffusion-weighted, and dynamic contrast enhance) imaging to determine applicator required for ideal coverage. Interstitial HDR-BT pts had catheters placed in the MR room. Sequences performed post applicator insertion included T2-Space and high-res T2. Contouring of gross tumor volume (GTV), clinical target volume (CTV) of vagina, additional gynecologic organs if present (uterus, cervix), and normal tissues was performed based on an internal protocol. Interstitial cases had a subsequent CT scan to validate catheter digitization. Patient characteristics, treatment toxicity, and prognostic markers were analyzed. Kaplan-Meier (KM) estimates were generated for disease-free survival (DFS), local control (LC), and overall survival (OS).</div></div><div><h3>Results</h3><div>41 pts were included. Median age was 61 yrs (range 33 - 90); median follow up was 28 months. Stage: FIGO I - 9 (22%), FIGO II - 11 (26.8%), FIGO III - 9 (22%), FIGO IV - 7 (17%), and recurrent - 5 (12.2%). 30 pts (73%) were squamous cell carcinoma, 5 pts (12.2%) were adenocarcinoma. RT with both EBRT+HDR-BT was done in 35 (85.4%) cases. 6 (14.6%) pts received HDR-BT alone. Syed interstitial implant was used for 40 (97.5%); 1 received multichannel cylinder. 33 (80%) received concurrent systemic therapy, primarily with cisplatin (24 pts). Median MR-defined CTV volume was 19.9 cm<sup>3</sup> (range 0.77 cm<sup>3</sup> - 202.1 cm<sup>3</sup>). Among the pts with a measurable lesion on MRI, median pre-RT tumor size was 4.5 cm (range 1.2-16.6cm). Median size at 3-month MR was 2.8 cm (range 1.3-13.3cm). Among pts who received EBRT+HDR-BT, median total D90 EQD2 was 70.2 Gy (range 56.6-91.5Gy). Median bladder, rectum, sigmoid, and bowel total EQD2 were 62.7 Gy (range 47.9-88Gy), 59.8 Gy (range 50.7-83.5Gy), 50.3 Gy (range 39.7-78.4Gy), and 50.1 Gy (range 43.2-89.9Gy), respectfully. 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引用次数: 0

Abstract

Purpose

We report on recurrence patterns and prognostic features among pts treated definitively for primary vaginal cancer with placement of interstitial catheters in a magnetic resonance (MR) simulator and treatment in an adjacent brachytherapy suite.

Methods

The cohort included 53 pts receiving radiotherapy (RT) for primary vaginal cancer from 9/2016-1/2022 at a single institution. Pts received external beam radiation (EBRT) plus high-dose rate brachytherapy (HDR-BT) (w/ MR guidance, Espree, Siemens, Inc.), or HDR-BT alone in the following settings: prior history of anal cancer s/p RT, early stage I, multiple co-morbidities w/ severe colitis or limited life expectancy. HDR-BT was delivered via Syed interstitial template or multichannel cylinder. Pre-procedure, pts had MR (T1-, T2-, diffusion-weighted, and dynamic contrast enhance) imaging to determine applicator required for ideal coverage. Interstitial HDR-BT pts had catheters placed in the MR room. Sequences performed post applicator insertion included T2-Space and high-res T2. Contouring of gross tumor volume (GTV), clinical target volume (CTV) of vagina, additional gynecologic organs if present (uterus, cervix), and normal tissues was performed based on an internal protocol. Interstitial cases had a subsequent CT scan to validate catheter digitization. Patient characteristics, treatment toxicity, and prognostic markers were analyzed. Kaplan-Meier (KM) estimates were generated for disease-free survival (DFS), local control (LC), and overall survival (OS).

Results

41 pts were included. Median age was 61 yrs (range 33 - 90); median follow up was 28 months. Stage: FIGO I - 9 (22%), FIGO II - 11 (26.8%), FIGO III - 9 (22%), FIGO IV - 7 (17%), and recurrent - 5 (12.2%). 30 pts (73%) were squamous cell carcinoma, 5 pts (12.2%) were adenocarcinoma. RT with both EBRT+HDR-BT was done in 35 (85.4%) cases. 6 (14.6%) pts received HDR-BT alone. Syed interstitial implant was used for 40 (97.5%); 1 received multichannel cylinder. 33 (80%) received concurrent systemic therapy, primarily with cisplatin (24 pts). Median MR-defined CTV volume was 19.9 cm³ (range 0.77 cm³ - 202.1 cm³). Among the pts with a measurable lesion on MRI, median pre-RT tumor size was 4.5 cm (range 1.2-16.6cm). Median size at 3-month MR was 2.8 cm (range 1.3-13.3cm). Among pts who received EBRT+HDR-BT, median total D90 EQD2 was 70.2 Gy (range 56.6-91.5Gy). Median bladder, rectum, sigmoid, and bowel total EQD2 were 62.7 Gy (range 47.9-88Gy), 59.8 Gy (range 50.7-83.5Gy), 50.3 Gy (range 39.7-78.4Gy), and 50.1 Gy (range 43.2-89.9Gy), respectfully. For the pts who received HDR-BT only, median D90 EQD2 was 39.1 Gy (range 14.3-74.5Gy). Median bladder, rectum, sigmoid, and bowel EQD2 were 24.4 Gy (range 6.7-50.5Gy), 33.6 Gy (range 2.2-37.6Gy), 9 Gy (range 1.7-20.6Gy), and 2.4 Gy (range 2.3-28.3Gy). 12 pts progressed, none with local-only failure. 6 pts (46% of recurrences) progressed in multiple sites at recurrence. Disease spread distribution includes: Distant only = 7, distant+local = 2, regional LN only = 2, regional LN+local = 1. Sites of distant recurrence were lung (5), liver (3), and brain (4). Of these recurrences, 2 were in the HDR-BT only group (liver only and lung + local) and the remaining were in the EBRT + HDR BT group. For the entire cohort, 1 year OS was 82%, 2-year OS was 67%, and median OS was 5 years. 2-year DFS was 78% and 2-year LC was 93%. For the EBRT + HDR BT cohort vs. HDR-BT only cohort, 1 year OS was 80% vs. 66%, 2-year OS was 51% vs. 50%, 2-year DFS was 77% vs. 66%, and 2-year LC was 94% vs. 83%, respectively. The most common any grade treatment-related toxicity at 90-day follow up was vaginal pain, experienced by 15/40 pts. At 180-day follow up, this decreased to 8/32 pts. 6 (14.6%) pts experienced Grade 3 toxicity; 2 treated with argon laser ablation for rectal bleeding, 2 with hyperbaric oxygen for vaginal necrosis, 1 with colostomy + ileal conduit for colovesicular+colovaginal fistula, and 1 with surgical dilation for severe vaginal stenosis.

Conclusions

In this series, MR-guided HDR-BT for primary vaginal cancer yields high rates of local control with limited grade 3+ toxicities, but lower rates of distant control indicate consideration for systemic therapy is warranted.

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GPP06 演讲时间：上午 11:15

目的我们报告了原发性阴道癌患者在磁共振（MR）模拟器中置入间质导管并在相邻的近距离放射治疗室中接受明确治疗后的复发模式和预后特征。方法队列中包括 53 名在一家机构接受放射治疗（RT）的原发性阴道癌患者，时间为 2016 年 9 月至 2022 年 1 月。患者接受了外照射（EBRT）加高剂量率近距离放射治疗（HDR-BT）（使用MR引导，Espree，西门子公司），或单独接受HDR-BT治疗，具体情况如下：既往肛门癌病史（接受过RT治疗）、早期I期、合并多种疾病（包括严重结肠炎）或预期寿命有限。HDR-BT 通过 Syed 间质模板或多通道圆筒进行放射治疗。术前，患者接受磁共振（T1、T2、弥散加权和动态对比增强）成像，以确定理想覆盖所需的涂抹器。间质 HDR-BT 患者在磁共振室放置导管。应用器插入后进行的序列包括 T2-空间和高分辨率 T2。根据内部协议对肿瘤总体积（GTV）、阴道临床目标体积（CTV）、其他妇科器官（如子宫、宫颈）和正常组织进行轮廓分析。间质病例随后需要进行 CT 扫描，以验证导管数字化。对患者特征、治疗毒性和预后指标进行了分析。对无病生存率（DFS）、局部控制率（LC）和总生存率（OS）进行了卡普兰-梅耶（KM）估计。中位年龄为 61 岁（33 - 90 岁）；中位随访时间为 28 个月。分期：FIGO I - 9例（22%），FIGO II - 11例（26.8%），FIGO III - 9例（22%），FIGO IV - 7例（17%），复发 - 5例（12.2%）。30例（73%）为鳞癌，5例（12.2%）为腺癌。35例（85.4%）患者同时接受了EBRT+HDR-BT治疗。6名患者（14.6%）仅接受了HDR-BT治疗。40例（97.5%）使用了Syed间质植入；1例使用了多通道圆筒。33例（80%）患者同时接受了系统治疗，主要是顺铂（24例）。MR 定义的 CTV 体积中位数为 19.9 cm3（范围为 0.77 cm3 - 202.1 cm3）。在MRI上有可测量病灶的患者中，RT前肿瘤大小的中位数为4.5厘米（范围为1.2-16.6厘米）。3个月磁共振成像的中位肿瘤大小为2.8厘米（范围为1.3-13.3厘米）。在接受 EBRT+HDR-BT 的患者中，D90 EQD2 总剂量中位数为 70.2 Gy（范围 56.6-91.5Gy）。膀胱、直肠、乙状结肠和肠道总 EQD2 的中位数分别为 62.7 Gy（范围 47.9-88Gy）、59.8 Gy（范围 50.7-83.5Gy）、50.3 Gy（范围 39.7-78.4Gy）和 50.1 Gy（范围 43.2-89.9Gy）。仅接受 HDR-BT 治疗的患者的 D90 EQD2 中位数为 39.1 Gy（范围为 14.3-74.5Gy）。膀胱、直肠、乙状结肠和肠道的 EQD2 中位数分别为 24.4 Gy（范围 6.7-50.5Gy）、33.6 Gy（范围 2.2-37.6Gy）、9 Gy（范围 1.7-20.6Gy）和 2.4 Gy（范围 2.3-28.3Gy）。12例患者病情进展，但无一例局部失败。6名患者（占复发患者的46%）在复发时多个部位出现进展。疾病扩散分布包括远处复发=7例，远处+局部复发=2例，区域LN复发=2例，区域LN+局部复发=1例。远处复发部位为肺（5 例）、肝（3 例）和脑（4 例）。在这些复发部位中，2 例发生在仅 HDR-BT 组（仅肝脏和肺+局部），其余发生在 EBRT + HDR BT 组。整个组群的 1 年 OS 为 82%，2 年 OS 为 67%，中位 OS 为 5 年。2年DFS为78%，2年LC为93%。EBRT+HDR-BT队列与仅HDR-BT队列相比，1年OS分别为80%对66%，2年OS为51%对50%，2年DFS为77%对66%，2年LC为94%对83%。在90天的随访中，最常见的任何等级的治疗相关毒性是阴道疼痛，有15/40例。在 180 天的随访中，这一比例降至 8/32。6名患者（14.6%）出现了3级毒性；其中2名患者因直肠出血接受了氩激光消融治疗，2名患者因阴道坏死接受了高压氧治疗，1名患者因结肠+阴道瘘接受了结肠造口+回肠导管治疗，1名患者因严重阴道狭窄接受了手术扩张治疗。结论在该系列研究中，MR引导下的HDR-BT治疗原发性阴道癌的局部控制率较高，3+级毒性反应有限，但远处控制率较低，表明需要考虑全身治疗。

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

Brachytherapy 医学-核医学

CiteScore

3.40

自引率

21.10%

发文量

119

审稿时长

9.1 weeks

期刊介绍： Brachytherapy is an international and multidisciplinary journal that publishes original peer-reviewed articles and selected reviews on the techniques and clinical applications of interstitial and intracavitary radiation in the management of cancers. Laboratory and experimental research relevant to clinical practice is also included. Related disciplines include medical physics, medical oncology, and radiation oncology and radiology. Brachytherapy publishes technical advances, original articles, reviews, and point/counterpoint on controversial issues. Original articles that address any aspect of brachytherapy are invited. Letters to the Editor-in-Chief are encouraged.