Factors Affecting D90 High-risk Clinical Target Volumes (HR-CTV dose) of Intracavitary and Interstitial Brachytherapy in Locally Advanced Cervical Cancer.

IF 3.2 3区医学 Q2 ONCOLOGY

Clinical oncology Pub Date : 2025-01-01 Epub Date: 2024-11-28 DOI:10.1016/j.clon.2024.103701

P Chitmanee, T Sampaongen, N Klomjit

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Abstract

Aims: Intracavitary brachytherapy alone covers a limited target volume; however, intracavitary and interstitial brachytherapy (IC/IS) can increase the dose coverage. We aim to assess the factors that impact D90 high-risk clinical target volume (HR-CTV) dose. We also assess clinical outcomes and toxicities for 3D image-based brachytherapy.

Materials and methods: We included a total of 424 cervical cancer patients with FIGO stage IB1 to IVA who received chemoradiation and high-dose-rate brachytherapy between 2014 and 2023. Target delineation was per GEC-ESTRO guidelines with the aim to achieve total dose of ≥85 Gy (D90 HR-CTV) in equivalent dose (EQD2). Implantation, tumour size, lateral extension, and HR-CTV volume were analysed.

Results: The median follow-up time was 24 months (range 1-107). The overall 2-year local control, progression-free survival, and overall survival rate were 90.3%, 75%, and 95.5%, respectively. Of 424 patients, 86.8% received a total dose of at least 85 Gy of D90 HR-CTV in EQD2. In multivariate analysis, IC/IS brachytherapy and HR-CTV volume were significant factors associated with HR-CTV D90 ≥ 85Gy in EQD2 (P = 0.012 and P = 0.000, respectively). Subgroup analysis of patients with HR-CTV volume >35 ml found that IC/IS was a significant factor in achieving HR-CTV D90 ≥ 85Gy in EQD2 (P = 0.017). At the median follow-up, patients with D90 HR-CTV ≥85 Gy achieved local control rates of 72.08% in small volume (<20 cm³) group, 68.42% in intermediate volume (21-30 cm³) group, 71.68% in high intermediate volume (31-60 cm³) and 17.67% in larger volume (>60 cm³) group (P = 0.005). Grade 3 toxicities including proctitis, cystitis, and vaginal stenosis were 7.1%, 1.9% and 0.2%, respectively.

Conclusion: IC/IS brachytherapy may be used in patients with HR-CTV volumes greater than 35 ml to achieve total doses of D90 HR-CTV ≥85 Gy in EQD2. IC/IS brachytherapy also provide good local control with favorable toxicity profile.

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影响局部晚期宫颈癌腔内和间质近距离治疗 D90 高风险临床靶体积（HR-CTV 剂量）的因素。

目的：单纯腔内近距离治疗覆盖的靶体积有限；然而，腔内和间质近距离治疗（IC/IS）可以增加剂量覆盖范围。我们旨在评估影响 D90 高风险临床靶体积（HR-CTV）剂量的因素。我们还评估了基于三维图像的近距离放射治疗的临床效果和毒性：我们纳入了2014年至2023年期间接受化疗和高剂量率近距离治疗的424例FIGO IB1至IVA期宫颈癌患者。根据 GEC-ESTRO 指南划分靶点，目标是达到等效剂量 (EQD2) 总剂量≥85Gy（D90 HR-CTV）。对植入情况、肿瘤大小、侧向扩展和HR-CTV体积进行了分析：中位随访时间为24个月（1-107个月）。2年局部控制率、无进展生存率和总生存率分别为90.3%、75%和95.5%。在424名患者中，86.8%的患者接受了总剂量至少为85 Gy的EQD2 D90 HR-CTV。在多变量分析中，IC/IS近距离治疗和HR-CTV体积是EQD2中HR-CTV D90≥85Gy的重要相关因素（分别为P = 0.012和P = 0.000）。对HR-CTV体积大于35毫升的患者进行亚组分析发现，IC/IS是EQD2达到HR-CTV D90 ≥ 85Gy的重要因素（P = 0.017）。在中位随访中，D90 HR-CTV ≥85 Gy 的患者的局部控制率在小体积（3）组为 72.08%，在中等体积（21-30 cm3）组为 68.42%，在高中等体积（31-60 cm3）组为 71.68%，在较大体积（>60 cm3）组为 17.67%（P = 0.005）。包括直肠炎、膀胱炎和阴道狭窄在内的3级毒性分别为7.1%、1.9%和0.2%：IC/IS近距离治疗可用于HR-CTV体积大于35 ml的患者，以达到EQD2中D90 HR-CTV ≥85 Gy的总剂量。IC/IS近距离放射治疗还能提供良好的局部控制，并具有良好的毒性。

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

Clinical oncology 医学-肿瘤学

CiteScore

5.20

自引率

8.80%

发文量

332

审稿时长

40 days

期刊介绍： Clinical Oncology is an International cancer journal covering all aspects of the clinical management of cancer patients, reflecting a multidisciplinary approach to therapy. Papers, editorials and reviews are published on all types of malignant disease embracing, pathology, diagnosis and treatment, including radiotherapy, chemotherapy, surgery, combined modality treatment and palliative care. Research and review papers covering epidemiology, radiobiology, radiation physics, tumour biology, and immunology are also published, together with letters to the editor, case reports and book reviews.