The influence of time and implants in high-dose rate image-guided adaptive brachytherapy for locally advanced cervical cancer

IF 1.7 4区医学 Q4 ONCOLOGY

Brachytherapy Pub Date : 2025-03-01 DOI:10.1016/j.brachy.2024.11.010

Leonel Varela Cagetti , Laurence Gonzague-Casabianca , Marjorie Ferré , Julia Gilhodes , Eric Lambaudie , Guillaume Blache , Camille Jauffret , Magalie Provansal , Renaud Sabatier , Agnès Tallet

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引用次数: 0

Abstract

PURPOSE

To compare the clinical outcomes of two different schedules of modern image-guided adaptive brachytherapy (IGABT) in patients underwent chemoradiotherapy (CCRT) and high-dose rate (HDR) brachytherapy (BT) for locally advanced cervical cancer treated (LACC)

METHODS AND MATERIALS

Data from medical records of all consecutive patients with histologically proven cervical cancer (FIGO 2018 stage IB-IVA) treated by HDR-BT after CCRT at our institution between 2016 and 2021 were reviewed.

RESULTS

Two hundred and 8 patients with LACC FIGO 2018 stages (IB 20.7%; II 26.5%, III 51%, IVA 1.9%) underwent brachytherapy at our institution. Depending on initial clinical features of disease and the clinical response to CCRT, HDR-BT was delivered with one implant (BT1i) or two implants (BT2i) in 39% and 61% of patients respectively. FIGO stages (≥IIB) were 63% vs. 78% for BT1i and BT2i patient group respectively. Combined brachytherapy technique [endocavitary/interstitial (IC/IS)] was required in 14.8% vs. 68.5% for BT1i and BT2i respectively. With a median follow-up of 32.5 months (95% confidence interval, [29.7–35.8]), local relapse was observed in sixteen patients: 8 patients (3.8%) had local (exclusive) relapse and 8 patients (3.8%) had locally persistent and progressive disease, without significant difference for each BT modality group (p = 0.27), even if BT2i group had more aggressive initial disease. The estimated 3-year disease free survival and overall survival for the entire population was 69% (95% confidence interval, [62–75%]) and 88% (95% confidence interval, [82–92%]) respectively. There was a significant difference in the incidence of global toxicity grade G≥2 in favour to the BT2i group (p = 0.026).

CONCLUSIONS

HDR brachytherapy delivered with a long time interval between fractions, two implants, and combined IC/IS brachytherapy is the best way to ensure local control and to perform IGABT with low toxicity, even in advanced stages of disease.

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时间和植入物对高剂量率影像引导下局部晚期宫颈癌适应性近距离放疗的影响。

目的：比较两种不同方案的现代图像引导适应性近距离放射治疗（IGABT）在局部晚期宫颈癌治疗（LACC）中接受放化疗（CCRT）和高剂量率（HDR）近距离放射治疗（BT）的临床结果。方法和材料：回顾我院2016年至2021年所有连续经组织学证实的宫颈癌患者（FIGO 2018 IB-IVA期）在CCRT后接受HDR-BT治疗的数据。结果：188例LACC FIGO 2018期患者(IB 20.7%；II期26.5%，III期51%，IVA期1.9%)在我院接受了近距离治疗。根据疾病的初始临床特征和对CCRT的临床反应，HDR-BT分别在39%和61%的患者中使用一个种植体（BT1i）或两个种植体（BT1i）进行递送。FIGO分期（≥IIB）在BT1i和BT1i患者组分别为63%和78%。BT1i和BT1i需要联合近距离治疗技术[腔内/间质（IC/IS）]分别为14.8%和68.5%。中位随访32.5个月（95%可信区间，[29.7-35.8]），16例患者出现局部复发：8例患者（3.8%）为局部（独家）复发，8例患者（3.8%）为局部持续进展性疾病，尽管BT2i组的初始疾病更具侵袭性，但各BT模式组间无显著差异（p = 0.27）。估计整个人群的3年无病生存率和总生存率分别为69%（95%置信区间，[62-75%]）和88%（95%置信区间，[82-92%]）。总体毒性等级G≥2的发生率与BT2i组有显著差异（p = 0.026）。结论：HDR近距离放疗间隔较长，两次植入物，以及IC/IS联合近距离放疗是确保局部控制和低毒性进行IGABT的最佳方法，即使在疾病晚期也是如此。

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.