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Title :Computed tomography–based image-guided brachytherapy for cervical cancer : correlations between dose–volume parameters and clinical outcomes
Authors :Kusada, Takeaki
Toita, Takafumi
Ariga, Takuro
Maemoto, Hitoshi
Hashimoto, Seiji
Shiina, Hideki
Kakinohana, Yasumasa
Joichi, Heianna
Nagai, Yutaka
Kudaka, Wataru
Aoki, Youichi
Murayama, Sadayuki
Issue Date :Jan-2018
Abstract :This study evaluated the oncologic outcomes and complications of cervical cancer patients in terms of CT-based image-guided brachytherapy (IGBT) parameters. Of 68 cervical cancer patients treated with definitive radiotherapy/concurrent chemoradiotherapy, most received whole-pelvis external beam RT (EBRT) of 40 Gy in 20 fractions, pelvic EBRT with central shield of 10 Gy in 5 fractions, and CT-based IGBT of 18 Gy in 3 fractions prescribed to point A. Cumulative EBRT and IGBT doses were calculated as the total equivalent dose in 2 Gy fractions (EQD2). The median follow-up was 31 (3–52) months. The 2-year overall survival, local control, pelvic control, and disease-free survival rates of the 68 patients were 92%, 83%, 82% and 73%, respectively. The HR-CTV D90, length from the tandem axis to left/right margin of the HR-CTV (T-LR), and HR-CTV volume were significant IGBT parameters for predicting local/pelvic control. Patients who received an HR-CTV D90 of >60 Gy, compared with ≤60 Gy, had significantly better local/pelvic control. Furthermore, 70 Gy was a marginally significant HR-CTV D90 cut-off affecting local control. T-LR was an independent IGBT parameter predicting local/pelvic control on multivariate analysis. Three patients developed Grade 3 or higher treatment-related complications. The D2cm3 of organs at risk were not significant predictors of complications. Future challenges for further improving outcomes include additional interstitial needles for irregularly shaped HR-CTVs, and moderate dose escalation, especially for patients with poor tumor responses.
URL :https://doi.org/10.1093/jrr/rrx065
Type Local :雑誌掲載論文
ISSN :0449-3060
Publisher :Oxford University Press
URI :http://hdl.handle.net/20.500.12000/45946
Citation :Journal of Radiation Research Vol.59 no.1 p.67 -76
Appears in Collections:Peer-reviewed Journal Articles (Faculty of Medicine)

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