{"title":"影响局部晚期宫颈癌腔内和间质近距离治疗 D90 高风险临床靶体积（HR-CTV 剂量）的因素。","authors":"P Chitmanee, T Sampaongen, N Klomjit","doi":"10.1016/j.clon.2024.103701","DOIUrl":null,"url":null,"abstract":"<p><strong>Aims: </strong>Intracavitary brachytherapy alone covers a limited target volume; however, intracavitary and interstitial brachytherapy (IC/IS) can increase the dose coverage. We aim to assess the factors that impact D90 high-risk clinical target volume (HR-CTV) dose. We also assess clinical outcomes and toxicities for 3D image-based brachytherapy.</p><p><strong>Materials and methods: </strong>We included a total of 424 cervical cancer patients with FIGO stage IB1 to IVA who received chemoradiation and high-dose-rate brachytherapy between 2014 and 2023. Target delineation was per GEC-ESTRO guidelines with the aim to achieve total dose of ≥85 Gy (D90 HR-CTV) in equivalent dose (EQD2). Implantation, tumour size, lateral extension, and HR-CTV volume were analysed.</p><p><strong>Results: </strong>The median follow-up time was 24 months (range 1-107). The overall 2-year local control, progression-free survival, and overall survival rate were 90.3%, 75%, and 95.5%, respectively. Of 424 patients, 86.8% received a total dose of at least 85 Gy of D90 HR-CTV in EQD2. In multivariate analysis, IC/IS brachytherapy and HR-CTV volume were significant factors associated with HR-CTV D90 ≥ 85Gy in EQD2 (P = 0.012 and P = 0.000, respectively). Subgroup analysis of patients with HR-CTV volume >35 ml found that IC/IS was a significant factor in achieving HR-CTV D90 ≥ 85Gy in EQD2 (P = 0.017). At the median follow-up, patients with D90 HR-CTV ≥85 Gy achieved local control rates of 72.08% in small volume (<20 cm<sup>3</sup>) group, 68.42% in intermediate volume (21-30 cm<sup>3</sup>) group, 71.68% in high intermediate volume (31-60 cm<sup>3</sup>) and 17.67% in larger volume (>60 cm<sup>3</sup>) group (P = 0.005). Grade 3 toxicities including proctitis, cystitis, and vaginal stenosis were 7.1%, 1.9% and 0.2%, respectively.</p><p><strong>Conclusion: </strong>IC/IS brachytherapy may be used in patients with HR-CTV volumes greater than 35 ml to achieve total doses of D90 HR-CTV ≥85 Gy in EQD2. IC/IS brachytherapy also provide good local control with favorable toxicity profile.</p>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"37 ","pages":"103701"},"PeriodicalIF":3.2000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Factors Affecting D90 High-risk Clinical Target Volumes (HR-CTV dose) of Intracavitary and Interstitial Brachytherapy in Locally Advanced Cervical Cancer.\",\"authors\":\"P Chitmanee, T Sampaongen, N Klomjit\",\"doi\":\"10.1016/j.clon.2024.103701\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aims: </strong>Intracavitary brachytherapy alone covers a limited target volume; however, intracavitary and interstitial brachytherapy (IC/IS) can increase the dose coverage. We aim to assess the factors that impact D90 high-risk clinical target volume (HR-CTV) dose. We also assess clinical outcomes and toxicities for 3D image-based brachytherapy.</p><p><strong>Materials and methods: </strong>We included a total of 424 cervical cancer patients with FIGO stage IB1 to IVA who received chemoradiation and high-dose-rate brachytherapy between 2014 and 2023. Target delineation was per GEC-ESTRO guidelines with the aim to achieve total dose of ≥85 Gy (D90 HR-CTV) in equivalent dose (EQD2). Implantation, tumour size, lateral extension, and HR-CTV volume were analysed.</p><p><strong>Results: </strong>The median follow-up time was 24 months (range 1-107). The overall 2-year local control, progression-free survival, and overall survival rate were 90.3%, 75%, and 95.5%, respectively. Of 424 patients, 86.8% received a total dose of at least 85 Gy of D90 HR-CTV in EQD2. In multivariate analysis, IC/IS brachytherapy and HR-CTV volume were significant factors associated with HR-CTV D90 ≥ 85Gy in EQD2 (P = 0.012 and P = 0.000, respectively). Subgroup analysis of patients with HR-CTV volume >35 ml found that IC/IS was a significant factor in achieving HR-CTV D90 ≥ 85Gy in EQD2 (P = 0.017). At the median follow-up, patients with D90 HR-CTV ≥85 Gy achieved local control rates of 72.08% in small volume (<20 cm<sup>3</sup>) group, 68.42% in intermediate volume (21-30 cm<sup>3</sup>) group, 71.68% in high intermediate volume (31-60 cm<sup>3</sup>) and 17.67% in larger volume (>60 cm<sup>3</sup>) group (P = 0.005). Grade 3 toxicities including proctitis, cystitis, and vaginal stenosis were 7.1%, 1.9% and 0.2%, respectively.</p><p><strong>Conclusion: </strong>IC/IS brachytherapy may be used in patients with HR-CTV volumes greater than 35 ml to achieve total doses of D90 HR-CTV ≥85 Gy in EQD2. IC/IS brachytherapy also provide good local control with favorable toxicity profile.</p>\",\"PeriodicalId\":10403,\"journal\":{\"name\":\"Clinical oncology\",\"volume\":\"37 \",\"pages\":\"103701\"},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2025-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical oncology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.clon.2024.103701\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/11/28 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.clon.2024.103701","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/11/28 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}
Factors Affecting D90 High-risk Clinical Target Volumes (HR-CTV dose) of Intracavitary and Interstitial Brachytherapy in Locally Advanced Cervical Cancer.
Aims: Intracavitary brachytherapy alone covers a limited target volume; however, intracavitary and interstitial brachytherapy (IC/IS) can increase the dose coverage. We aim to assess the factors that impact D90 high-risk clinical target volume (HR-CTV) dose. We also assess clinical outcomes and toxicities for 3D image-based brachytherapy.
Materials and methods: We included a total of 424 cervical cancer patients with FIGO stage IB1 to IVA who received chemoradiation and high-dose-rate brachytherapy between 2014 and 2023. Target delineation was per GEC-ESTRO guidelines with the aim to achieve total dose of ≥85 Gy (D90 HR-CTV) in equivalent dose (EQD2). Implantation, tumour size, lateral extension, and HR-CTV volume were analysed.
Results: The median follow-up time was 24 months (range 1-107). The overall 2-year local control, progression-free survival, and overall survival rate were 90.3%, 75%, and 95.5%, respectively. Of 424 patients, 86.8% received a total dose of at least 85 Gy of D90 HR-CTV in EQD2. In multivariate analysis, IC/IS brachytherapy and HR-CTV volume were significant factors associated with HR-CTV D90 ≥ 85Gy in EQD2 (P = 0.012 and P = 0.000, respectively). Subgroup analysis of patients with HR-CTV volume >35 ml found that IC/IS was a significant factor in achieving HR-CTV D90 ≥ 85Gy in EQD2 (P = 0.017). At the median follow-up, patients with D90 HR-CTV ≥85 Gy achieved local control rates of 72.08% in small volume (<20 cm3) group, 68.42% in intermediate volume (21-30 cm3) group, 71.68% in high intermediate volume (31-60 cm3) and 17.67% in larger volume (>60 cm3) group (P = 0.005). Grade 3 toxicities including proctitis, cystitis, and vaginal stenosis were 7.1%, 1.9% and 0.2%, respectively.
Conclusion: IC/IS brachytherapy may be used in patients with HR-CTV volumes greater than 35 ml to achieve total doses of D90 HR-CTV ≥85 Gy in EQD2. IC/IS brachytherapy also provide good local control with favorable toxicity profile.
期刊介绍：
Clinical Oncology is an International cancer journal covering all aspects of the clinical management of cancer patients, reflecting a multidisciplinary approach to therapy. Papers, editorials and reviews are published on all types of malignant disease embracing, pathology, diagnosis and treatment, including radiotherapy, chemotherapy, surgery, combined modality treatment and palliative care. Research and review papers covering epidemiology, radiobiology, radiation physics, tumour biology, and immunology are also published, together with letters to the editor, case reports and book reviews.
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