Prognostic factors of local control and progression-free survival in AJCC stages T1 and T2 cervical cancer patients treated with adjuvant brachytherapy after chemoradiotherapy.

IF 1.1 4区医学 Q4 ONCOLOGY

Journal of Contemporary Brachytherapy Pub Date : 2023-02-01 DOI:10.5114/jcb.2023.124936

Jean-Christophe Faivre, Paul Jung, Julia Salleron, Florian Baumard, Florent Courrech, Frédéric Marchal, Didier Peiffert, Sophie Renard, Claire Charra-Brunaud

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Abstract

Purpose: We assessed prognostic factors of local control and progression-free survival (PFS) of patients treated for AJCC stages T1 and T2 cervical cancer using utero-vaginal brachytherapy after chemoradiotherapy.

Material and methods: This retrospective single-institution analysis included patients who underwent brachytherapy after radiochemotherapy between 2005 and 2015 at the Institut de Cancérologie de Lorraine. Adjuvant hysterectomy was optional. A multivariate analysis of prognostic factors was carried out.

Results: Of 218 patients, 81 (37.2%) were AJCC stage T1, and 137 (62.8%) were AJCC stage T2. 167 (76.6%) patients had squamous cell carcinoma, 97 (44.5%) patients had pelvic nodal disease, and 30 (13.8%) patients had para-aortic nodal disease. One hundred eighty-four patients (84.4%) underwent concomitant chemotherapy, while adjuvant surgery was performed in 91 patients (41.9%) and 42 (46.2%) patients had pathological complete response. Median follow-up was 4.2 years, and local control was reported in 87.8% (95% CI: 83.0-91.8) and 87.2% (95% CI: 82.3-91.3) of patients at 2 and 5 years, respectively. In multivariate analysis, T stage (hazard ratio [HR] = 3.65, 95% CI: 1.27-10.46, p = 0.016) was associated with local control. PFS was reported in 67.6% (95% CI: 60.9-73.4) and 57.4% (95% CI: 49.3-64.2) of patients at 2 and 5 years, respectively. In multivariate analysis, para-aortic nodal disease (HR = 2.03, 95% CI: 1.16-3.54, p = 0.012), pathological complete response (HR = 0.33, 95% CI: 0.15-0.73, p = 0.006), and intermediate-risk clinical tumor volume of > 60 cc (HR = 1.90, 95% CI: 1.22-2.98, p = 0.005) were associated with PFS.

Conclusions: Lower dose brachytherapy may benefit AJCC stages T1 and T2 tumors, whereas higher doses are required for larger tumors and para-aortic nodal disease involvement, respectively. Pathological complete response should be associated with better local control and not surgery.

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放化疗后辅助近距离放疗的AJCC T1期和T2期宫颈癌患者局部控制和无进展生存的预后因素

目的:我们评估AJCC T1期和T2期宫颈癌患者在放化疗后采用子宫阴道近距离治疗的局部控制和无进展生存(PFS)的预后因素。材料和方法:本回顾性单机构分析包括2005年至2015年间在洛林癌症研究所接受放化疗后近距离治疗的患者。辅助子宫切除术是可选的。对预后因素进行多变量分析。结果:218例患者中，AJCC T1期81例(37.2%)，T2期137例(62.8%)。167例(76.6%)患者有鳞状细胞癌，97例(44.5%)患者有盆腔淋巴结疾病，30例(13.8%)患者有主动脉旁淋巴结疾病。184例(84.4%)患者接受了化疗，91例(41.9%)患者接受了辅助手术，42例(46.2%)患者病理完全缓解。中位随访时间为4.2年，2年和5年分别有87.8% (95% CI: 83.0-91.8)和87.2% (95% CI: 82.3-91.3)的患者获得局部控制。在多因素分析中，T期(风险比[HR] = 3.65, 95% CI: 1.27-10.46, p = 0.016)与局部控制相关。在2年和5年，分别有67.6% (95% CI: 60.9-73.4)和57.4% (95% CI: 49.3-64.2)的患者报告PFS。在多因素分析中，主动脉旁淋巴结疾病(HR = 2.03, 95% CI: 1.16-3.54, p = 0.012)、病理完全缓解(HR = 0.33, 95% CI: 0.15-0.73, p = 0.006)、临床肿瘤体积> 60cc (HR = 1.90, 95% CI: 1.22-2.98, p = 0.005)与PFS相关。结论:低剂量近距离治疗可能有利于T1期和T2期AJCC肿瘤，而大肿瘤和累及主动脉旁淋巴结疾病分别需要高剂量治疗。病理完全缓解应与较好的局部控制有关，而不是手术。

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来源期刊

Journal of Contemporary Brachytherapy ONCOLOGY-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

2.40

自引率

14.30%

发文量

审稿时长

16 weeks

期刊介绍： The “Journal of Contemporary Brachytherapy” is an international and multidisciplinary journal that will publish papers of original research as well as reviews of articles. Main subjects of the journal include: clinical brachytherapy, combined modality treatment, advances in radiobiology, hyperthermia and tumour biology, as well as physical aspects relevant to brachytherapy, particularly in the field of imaging, dosimetry and radiation therapy planning. Original contributions will include experimental studies of combined modality treatment, tumor sensitization and normal tissue protection, molecular radiation biology, and clinical investigations of cancer treatment in brachytherapy. Another field of interest will be the educational part of the journal.