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首页> 外文期刊>Radiotherapy and oncology: Journal of the European Society for Therapeutic Radiology and Oncology >Local recurrences in cervical cancer patients in the setting of image-guided brachytherapy: a comparison of spatial dose distribution within a matched-pair analysis.
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Local recurrences in cervical cancer patients in the setting of image-guided brachytherapy: a comparison of spatial dose distribution within a matched-pair analysis.

机译：在图像引导的近距离放射治疗中，宫颈癌患者的局部复发：配对分析中空间剂量分布的比较。

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PURPOSE: It has been shown that a cumulative dose of >/=87 Gy (EQD2) of external beam radiotherapy (EBRT) and image guided adaptive brachytherapy (IGABT) to the high risk clinical target volume (HR CTV) confer a local control rate >95% in locally advanced cervical cancer. This study examines the dose distribution within the HR CTV and intermediate (IR) CTV in patients with cervical cancer treated with definitive EBRT +/- concomitant chemotherapy and MRI-based IGABT between patients with local recurrence (LR) and patients in continuous complete local remission (CCLR). MATERIAL AND METHODS: From 1998 to 2010, 265 patients were treated with definitive EBRT +/- concomitant chemotherapy and IGABT. Twenty-four LRs were documented. For the statistical analysis all patients with LR were matched to patients in CCLR from our database according to the following criteria: FIGO stage, histology, lymph node status, tumour size and chemotherapy. DVH parameters (D50, D90, D98, D100) were reported for HR CTV and IR CTV. In order to report the minimum dose in the region where the recurrence occurred, the HR CTV/IR CTV were divided into four quadrants on transversal planes. The minimum dose at the HR CTV/IR CTV contour was measured (within the corresponding quadrant closest to the LR) in the treatment planning system. A mean minimum point dose (MPD) was calculated by averaging these measurements on four consecutive slices at the level of the recurrence for each of the 4 brachytherapy fractions. EQD2 doses were calculated by summation of all BT and external beam therapy fractions. For each matched patient in the control group the measurements were performed on the same quadrant and at the same level. RESULTS: Sufficient image data were available for 21 LRs. Eight central failures and 13 non-central failures were observed. The mean D90 and D100 for HR CTV were 77 Gy and 61 Gy for patients with LR and 95 Gy and 71 Gy for patients in CCLR, respectively (p<0.01). The MPD for HR CTV was 72 Gy for patients in the LR arm and 99 Gy for patients in the CCLR arm (p<0.01). In the LR arm seven patients had a D90 for HR CTV >/=87 Gy, however, in only three patients the MPD was >/=87 Gy. CONCLUSION: This study demonstrated significant differences in local outcome according to the delivered dose. In 85% of the LRs systematic low dose regions with less than 87 Gy were found at HR CTV contour. Systematic low dose regions leading to local recurrence could be detected even if a D90 HR CTV >/=87 Gy was applied. In addition to DVH parameters, inspection of the spatial dose distribution remains a key point in dose prescription.
机译：目的：已经证明，对于高风险临床目标体积（HR CTV），外束放射疗法（EBRT）和图像引导自适应近距离放射疗法（IGABT）的累积剂量> / = 87 Gy（EQD2）赋予局部控制率> 95％的局部晚期宫颈癌。这项研究检查了接受局部EBRT +/-伴随化疗和基于MRI的IGABT治疗的子宫颈癌患者的HR CTV和中度（IR）CTV在局部复发（LR）和持续完全局部缓解的患者之间的剂量分布（CCLR）。材料与方法：从1998年至2010年，共有265例患者接受了确定的EBRT +/-伴随化疗和IGABT治疗。记录了二十四个LR。为了进行统计分析，根据以下标准，将我们数据库中的所有LR患者与CCLR患者进行了匹配：FIGO分期，组织学，淋巴结状态，肿瘤大小和化疗。报告了HR CTV和IR CTV的DVH参数（D50，D90，D98，D100）。为了报告复发发生区域的最小剂量，HR CTV / IR CTV在横向平面上分为四个象限。在治疗计划系统中（在最接近LR的相应象限内）测量HR CTV / IR CTV轮廓处的最小剂量。通过对四个近距离放射治疗部分中每一个的复发水平在四个连续切片上取平均这些平均测量值，可以计算出平均最小点剂量（MPD）。 EQD2剂量通过所有BT和外部束治疗分数的总和计算得出。对于对照组中每个匹配的患者，在相同的象限和相同的水平上进行测量。结果：有足够的图像数据可用于21个LR。观察到8个中央故障和13个非中央故障。对于LR患者，HR CTV的平均D90和D100分别为77 Gy和61 Gy，对于CCLR患者，其平均D90和D100分别为95 Gy和71 Gy（p <0.01）。 LR组患者HR CTV的MPD为72 Gy，CCLR组患者MPD为99 Gy（p <0.01）。在LR臂中，HR CTV的D90> / = 87 Gy为7名患者，但是，只有3名患者的MPD> / = 87 Gy。结论：该研究表明，根据给药剂量的不同，局部结局存在显着差异。在HR CTV等高线中，发现85％的LR小于87 Gy的系统性低剂量区域。即使使用D90 HR CTV> / = 87 Gy，也可以检测到导致局部复发的系统性低剂量区域。除了DVH参数外，对空间剂量分布的检查仍然是剂量处方中的关键点。

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