PET/CT-based dose-escalated definitive radiotherapy in cervical cancer: a single-institution series.

IF 1.2 Q4 ONCOLOGY

Reports of Practical Oncology and Radiotherapy Pub Date : 2025-02-19 eCollection Date: 2024-01-01 DOI:10.5603/rpor.104018

Samir A Hanna, Alice R N S Silva, Leticia Hernandes de Brito, Gabriela Silva Moreira de Siqueira, Tatiana Midori Martins Teles Alves, Daniela de Freitas, Rudinei Linck, José Carlos Sadalla, Sergio Mancini Nicolau, Carlos Buchpiguel, Jesus Paula Carvalho

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引用次数: 0

Abstract

Background: The objective was to evaluate clinical outcomes and toxicity of patients with cervical cancer treated by radiotherapy with dose escalation in involved lymph nodes based on positron emission tomography/computed tomography (PET/CT) staging.

Materials and methods: Retrospective cohort study involving locally advanced cervical neoplasms treated with definitive radiotherapy. Volumetric modulated arc therapy (VMAT), image-guided radiotherapy (IGRT), and registration of PET/CT were employed in all. Involved lymph nodes were given higher doses simultaneously.

Results: Between February 2012 and September 2023, there were 37 patients, with median age of 48 (range 27-91) years. Almost 70% were stages III/IVA. Two-thirds were given retroperitoneal irradiation. The mean delivered doses to primary tumor and to involved lymph nodes were, respectively, 52.5 Gy, and 62.5 Gy. The 10-year rates of overall survival, event-free survival, local-recurrence-free survival, and metastasis-free survival were, respectively, 76%, 50%, 91%, and 82%. There were 13 and 2 cases of gastrointestinal toxicity grades II and III, respectively. Grades II and III of genitourinary toxicity were seen respectively in 7 and 3 patients. On univariate analysis, age was related to local recurrence-free survival (LRFS); standard uptake values (SUV) was related to event-free survival (EFS); lymph node dose was related to overall survival (OS), and EFS; primary tumor dose was directly related to EFS, albeit inversely to the likelihood of grade > II gastrointestinal toxicity. Retroperitoneal irradiation improved LRFS, and rates of grade > II gastrointestinal toxicity. On multivariate analysis, SUV remained an independent predictor of EFS; lymph node dose was an independent predictor of OS, and age was an independent predictor of lymph node recurrence.

Conclusion: Dose escalation radiotherapy (RT) based on PET/CT for cervical cancer may be feasible and safe. Further robust study results are needed.

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基于PET/ ct剂量递增的宫颈癌最终放疗：单一机构系列。

背景：目的是基于正电子发射断层扫描/计算机断层扫描（PET/CT）分期评估宫颈癌患者在受累淋巴结进行剂量递增放疗的临床结果和毒性。材料和方法：回顾性队列研究涉及局部晚期宫颈肿瘤放疗治疗。所有患者均采用体积调制弧线治疗（VMAT）、图像引导放疗（IGRT）和PET/CT配准。受累淋巴结同时给予较高剂量。结果：2012年2月至2023年9月，37例患者，中位年龄48岁（27-91岁）。近70%为III/IVA期。三分之二给予腹膜后照射。原发肿瘤和受累淋巴结的平均递送剂量分别为52.5 Gy和62.5 Gy。10年总生存率、无事件生存率、局部无复发生存率和无转移生存率分别为76%、50%、91%和82%。II级和III级胃肠道毒性分别为13例和2例。II级和III级泌尿生殖系统毒性分别为7例和3例。单因素分析显示，年龄与局部无复发生存率（LRFS）相关；标准摄取值（SUV）与无事件生存期（EFS）相关；淋巴结剂量与总生存期（OS）和EFS相关；原发肿瘤剂量与EFS直接相关，尽管与bb0级胃肠道毒性的可能性呈负相关。腹膜后照射改善了LRFS，并降低了>级胃肠道毒性发生率。在多变量分析中，SUV仍然是EFS的独立预测因子；淋巴结剂量是OS的独立预测因子，年龄是淋巴结复发的独立预测因子。结论：基于PET/CT的剂量递增放疗（RT）治疗宫颈癌是可行且安全的。需要进一步的可靠研究结果。

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

Reports of Practical Oncology and Radiotherapy Multiple-

CiteScore

2.80

自引率

8.30%

发文量

115

审稿时长

16 weeks

期刊介绍： Reports of Practical Oncology and Radiotherapy is an interdisciplinary bimonthly journal, publishing original contributions in clinical oncology and radiotherapy, as well as in radiotherapy physics, techniques and radiotherapy equipment. Reports of Practical Oncology and Radiotherapy is a journal of the Polish Society of Radiation Oncology, the Czech Society of Radiation Oncology, the Hungarian Society for Radiation Oncology, the Slovenian Society for Radiotherapy and Oncology, the Polish Study Group of Head and Neck Cancer, the Guild of Bulgarian Radiotherapists and the Greater Poland Cancer Centre, affiliated with the Spanish Society of Radiotherapy and Oncology, the Italian Association of Radiotherapy and the Portuguese Society of Radiotherapy - Oncology.