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首页> 外文期刊>Radiotherapy and oncology: Journal of the European Society for Therapeutic Radiology and Oncology >The adverse effect of treatment prolongation in cervical cancer byhigh-dose-rate intracavitary brachytherapy.
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The adverse effect of treatment prolongation in cervical cancer byhigh-dose-rate intracavitary brachytherapy.

机译：高剂量率腔内近距离放射治疗延长宫颈癌的不良反应。

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BACKGROUND AND PURPOSE: The potential risk of prolongation of treatment time in cervical cancer has been reported for many low-dose rate (LDR) studies, with an estimated loss of local control ranging from 0.3 to 1.6% per day of treatment prolongation. Since the treatment schedule for fractionated high-dose rate intracavitary brachytherapy (HDRICB) is not directly comparable with that for low-dose rate studies, this report aims to evaluate the adverse effect of treatment prolongation specifically for cervical cancer treated with HDRICB. MATERIAL AND METHODS: From September 1992 to December 1997, 257 patients diagnosed with uterine cervical cancer (35 Ib, 26 IIa, 122 IIb, 10 IIIa, 57 IIIb, 7 IVa), who underwent external radiotherapy combined with between two and four courses of HDRICB and a minimum of 3 years of follow-up (median 57 months), were analyzed. Treatment consisted of irradiation of the whole pelvis with 44-45 Gy consisting of 22-25 fractions by 5 weeks, with the dose boosted to 54-58 Gy (withcentral shielding) for patients diagnosed as FIGO stage IIb-IVa bilateral parametrial disease. HDRICB was performed using an Ir-192 remote afterloading technique at 1-week intervals. The standard prescribed dose for each course of HDRICB was 7.2 Gy to point A for three insertions (before July 1995), or 6.0 Gy to point A for four insertions (after July 1995). Total prescribed point A doses (external beam radiotherapy+HDRICB) ranged from 58 to 71.6 Gy (median, 65.6 Gy) for stage IB-IIA, while analogous dosage for larger lesions (stage IIb-IVa) ranged from 59 to 75.6 Gy (median, 65.6 Gy). Kaplan-Meier and multivariate analyses were used to test the effect of treatment time on pelvic control rate (PCR) and cause-specific survival (CSS) at 5 years. RESULTS: Median treatment time was 63 days. For all stages of disease, the 5-year CSS and PCR were significantly different comparing treatment times of less than and greater than or equal to 63 days [83% and 65% (P=0.004], 93% and 83% (P=0.02), respectively]. These associations were also significant for stage Ib/IIa [97% and 79% (P=0.01), and 100% and 87% (P=0.02), respectively), but not for stage IIb [75% and 72% (P=0.79), and 93% and 87% (P=0.83), respectively] or stage III [66% and 49% (P=0.2), and 83% and 72% (P=0.21), respectively]. Multivariate analysis identified three prognostic factors for CSS, stage (P<0.001), tumor response to external RT (P=0.001), and overall treatment time (OTT; P=0.006). Prognostic factors for pelvic failure were stage (P<0.001), tumor response to external RT (P=0.001), and OTT (P=0.03). Prolongation of treatment time resulted in a daily decrease in pelvic control rate of 0.67% overall, and 0.43% for stage Ib-IIa, 0.57% for stage IIb, and 0.73% for stage III patients. CONCLUSION: Analysis of the data from the current study demonstrates that the adverse effect of treatment prolongation was observed later in the treatment course for the high-dose rate (HDR) series compared to the LDR analog, however, treatment-time prolongation still negatively influenced the cause-specific survival and pelvic control rate for both dosage groups.
机译：背景与目的：据报道，许多低剂量率（LDR）研究表明子宫颈癌延长治疗时间的潜在风险，估计每天治疗延长的局部控制范围为0.3％至1.6％。由于分次高剂量率腔内近距离放射治疗（HDRICB）的治疗方案与低剂量率研究不直接可比，因此本报告旨在评估延长治疗时间对HDRICB治疗宫颈癌的不良影响。材料与方法：从1992年9月至1997年12月，有257例被诊断为子宫宫颈癌的患者（35 Ib，26 IIa，122 IIb，10 IIIa，57 IIIb，7 IVa）接受了外部放射治疗，并接受了2至4个疗程的联合治疗。对HDRICB进行了至少3年的随访（平均57个月）。对于被诊断为FIGO IIb-IVa期双侧子宫旁部疾病的患者，治疗包括用44-45 Gy的放射线照射整个骨盆，该放射线由22-25个部分组成，持续5周，剂量增加到54-58 Gy（中央屏蔽）。 HDRICB使用Ir-192远程后加载技术每隔1周进行一次。 HDRICB的每个疗程的标准处方剂量为三针插入（A点）为7.2 Gy（1995年7月之前），四针插入A点为6.0 Gy（1995年7月之后）。 IB-IIA期的总处方A点剂量（外部束放射疗法+ HDRICB）为58至71.6 Gy（中位数，为65.6 Gy），而较大病变（IIb-IVa期）的相似剂量为59至75.6 Gy（中位数） ，65.6 Gy）。使用Kaplan-Meier和多变量分析来测试治疗时间对5年时骨盆控制率（PCR）和特定病因生存（CSS）的影响。结果：中位治疗时间为63天。对于所有疾病阶段，比较小于和大于或等于63天的治疗时间，其5年CSS和PCR显着不同[83％和65％（P = 0.004），93％和83％（P =这些关联对Ib / IIa期也很重要[分别为97％和79％（P = 0.01），以及100％和87％（P = 0.02）），但对于IIb期则无意义[75 ％和72％（P = 0.79），分别为93％和87％（P = 0.83）]或III期[66％和49％（P = 0.2），以及83％和72％（P = 0.21） ， 分别]。多因素分析确定了CSS的三个预后因素，分期（P <0.001），肿瘤对外部RT的反应（P = 0.001）和总治疗时间（OTT; P = 0.006）。骨盆衰竭的预后因素为分期（P <0.001），肿瘤对外部RT的反应（P = 0.001）和OTT（P = 0.03）。延长治疗时间导致每天骨盆控制率总体下降0.67％，Ib-IIa期为0.43％，IIb期为0.57％，III期患者为0.73％。结论：对当前研究数据的分析表明，与LDR类似物相比，高剂量率（HDR）系列在治疗过程中较晚观察到治疗延长的不利影响，但是治疗时间延长仍然受到负面影响两个剂量组的病因特异性存活率和骨盆控制率。

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