肿瘤体积对宫颈癌近期疗效及近距离放疗的影响

Tumor volume affects the short-term efficacy of cervical cancer and brachytherapy

目的探讨肿瘤体积对行根治性放化疗的局部晚期宫颈癌患者的放疗剂量和疗效的影响。方法回顾性分析2019年11月至2022年11月于广西医科大学附属肿瘤医院诊断为ⅡB-ⅣA期宫颈癌并行根治性放化疗的126例患者资料。通过Jamovi软件计算得到外照射放疗前、后肿瘤体积(pre-TV、post-TV)和肿瘤体积缩减率(TVRR)的截断值,并通过单因素和多因素分析探讨pre-TV、post-TV和TVRR对近期疗效、无进展生存(PFS)、近距离放疗(BT)方式、高危临床靶区(HR-CTV)和危及器官(OAR)剂量的影响。结果pre-TV≥67.03 cm^(3)、post-TV≥14.88 cm^(3)为6个月PFS和客观缓解率(ORR)的不良预后因素(P<0.05),其中post-TV为独立预后因素。TVRR≥73.0%组与<73.0%组的6个月PFS和ORR的差异均无统计学意义。pre-TV≥67.03 cm^(3)组中,单纯腔内近距离放疗(ICBT)、腔内联合组织间插植近距离放疗(IC/IS-BT)者均为36例(50%),而pre-TV<67.03 cm^(3)组中,ICBT和IC/IS-BT者分别41例(76%)、13例(24%)(P=0.003)。post-TV≥14.88 cm^(3)组中,ICBT和IC/IS-BT者分别为28例(47%)、32例(53%),而<14.88 cm^(3)组中分别为49例(72%)、17例(26%)(P=0.002)。TVRR≥73.0%组HR-CTV D90%剂量高于<73.0%组(P=0.014),但膀胱、直肠和小肠的D_(2cm^(3))剂量组间差异无统计学意义(P>0.05)。post-TV<14.88 cm^(3)组HR-CTV D90%剂量高于≥14.88 cm^(3)组(P<0.001),且post-TV≥14.88 cm^(3)组膀胱D_(2cm^(3))高于<14.88 cm^(3)组(P<0.05),两组间直肠和小肠D_(2cm^(3))剂量差异无统计学意义(P>0.05)。同期化疗次数≥4次组与<4次组间的6个月PFS和TVRR差异均无统计学意义。结论pre-TV和post-TV为局部晚期宫颈癌近期疗效和BT方式选择的影响因素。post-TV为独立预后因素,也间接影响了HR-CTV D90%和膀胱D_(2cm^(3))的剂量。增加同期化疗次数(≥4次)并不能提高TVRR和近期疗效。

Objective To evaluate the effect of tumor volume on the radiation dose and efficacy of locally advanced cervical cancer patients undergoing radical radiotherapy and chemotherapy.Methods Clinical data of 126 patients who were diagnosed with cervical cancer(stageⅡB-ⅣA)and underwent radical concurrent chemoradiotherapy in Guangxi Medical University Cancer Hospital from November 2019 to November 2022 were retrospectively analyzed.The cut-off values of tumor volume before(pre-TV)and after(post-TV)external radiotherapy and tumor volume reduction rate(TVRR)were calculated by Jamovi software.The effects of pre-TV,post-TV and TVRR on short-term efficacy,progression-free survival(PFS),brachytherapy(BT)mode,high-risk clinical target volume(HR-CTV)and organs at risk(OAR)dose were investigated by univariate and multivariate analyses.Results Pre-TV≥67.03 cm^(3)and post-TV≥14.88 cm^(3)were poor prognostic factors for 6-month PFS and objective response rate(ORR)(both P<0.05),and post-TV was an independent prognostic factor.In the TVRR≥73.0%and<73.0%groups,no statistical differences were observed in the 6-month PFS and ORR.In the pre-TV≥67.03 cm^(3)group,the cases number of intracavitary brachytherapy(ICBT)and intracavitary/interstitial brachytherapy(IC/IS-BT)was 36(50.0%),while in the pre-TV<67.03 cm^(3)group,the cases number of ICBT and IC/IS-BT was 41(76%)and 13(24%),respectively(P=0.003).In the post-TV≥14.88 cm^(3)group,the cases number of ICBT and IC/IS-BT was 28(47%)and 32(53%),while 49(72%)and 17(26%)in the post-TV<14.88 cm^(3)group,respectively(P=0.002).The dose of HR-CTV D90%in the TVRR≥73.0%group was significantly higher than that in the TVRR<73.0%group(P=0.014),but there was no significant difference in the dose of bladder D_(2cm^(3)),rectal D_(2cm^(3))and small intestine D_(2cm^(3))(all P>0.05).The dose of HR-CTV D90%in the post-TV<14.88 cm^(3)group was significantly higher than that in post-TV≥14.88 cm^(3)group(P<0.001),and the dose of bladder D_(2cm^(3))in the post-TV≥14.88 cm^(3)group was higher than that in the post-TV<14.88 cm^(3)group(P<0.05).There was no significant difference in the dose of rectal D_(2cm^(3))and small intestinal D_(2cm^(3))between two groups(both P>0.05).The number of concurrent chemotherapy(≥4 times vs.<4 times)had no statistical difference for 6-month PFS and TVRR.Conclusions Pre-TV and post-TV are the influencing factors of short-term efficacy and BT mode selection for locally advanced cervical cancer.Post-TV is an independent prognostic factor and also indirectly affects the dose of HR-CTV D90%and bladder D_(2cm^(3))Increasing the number of concurrent chemotherapy(≥4 times)does not improve TVRR and short-term efficacy.