This study retrospectively evaluates clinical outcomes of dose escalation to involved nodes using volumetric modulated arc therapy (VMAT) with simultaneous integrated boost (SIB) for node-positive locally advanced cervical cancer (LACC) at a single institution. Consecutive patients with node-positive LACC (FIGO2018IIIC1-IVA) who received definitive chemoradiotherapy by VMAT 45 Gy in 25 fractions with SIB to 55–57.5 Gy, followed by magnetic resonance image-guided adaptive brachytherapy (IGABT) between 2018 and 2022 were identified. A standardized strategy regarding nodal boost delivery and elective para-aortic (PAO) irradiation was employed. Primary endpoints were involved nodal control (INC) and regional nodal control (RNC). Secondary endpoints were pelvic control (PC), locoregional control (LRC), disease-free survival (DFS), overall survival (OS), failure pattern, and radiotherapy-related toxicities. A total of 234 involved nodes (182 pelvic and 52 PAO) in 54 patients, with a median of 3 involved nodes per patient (range 1–16), were analyzed. After a median follow-up of 19.6 months, excellent INC was achieved, with four (2%) boost-volume failures occurring in three patients. The 2-year actuarial RNC, PC, LRC, DFS, and OS were 93%, 87%, 87%, 78%, and 85%, respectively. Adenocarcinoma histology was associated with worse RNC (p= 0.02) and OS (p= 0.04), whereas the primary tumor maximum standardized uptake value (SUVmax) was associated with worse PC (p= 0.04) and LRC (p= 0.046) on univariate analysis. The incidence of grade ≥3 acute and late radiotherapy-related toxicity were 2% and 4%, respectively. Treatment of node-positive LACC with VMAT with SIB allows safe and effective dose escalation. The 5-year local experience demonstrated excellent treatment outcomes without additional toxicity.
本研究回顾性评估了单中心对淋巴结阳性局部晚期宫颈癌（LACC）采用容积旋转调强放疗（VMAT）联合同步整合推量（SIB）技术对受累淋巴结进行剂量递增的临床疗效。研究纳入了2018年至2022年间连续收治的淋巴结阳性LACC患者（FIGO2018 IIIC1-IVA期），这些患者均接受根治性放化疗，方案为VMAT 45 Gy/25次，并对受累淋巴结同步推量至55–57.5 Gy，随后接受磁共振图像引导的自适应近距离放疗（IGABT）。研究采用了关于淋巴结推量照射和选择性腹主动脉旁（PAO）照射的标准化策略。主要终点为受累淋巴结控制率（INC）和区域淋巴结控制率（RNC）。次要终点包括盆腔控制率（PC）、局部区域控制率（LRC）、无病生存率（DFS）、总生存率（OS）、失败模式以及放疗相关毒性。共分析了54例患者的234个受累淋巴结（盆腔182个，PAO 52个），每例患者中位受累淋巴结数为3个（范围1-16个）。中位随访19.6个月后，获得了优异的INC，仅3例患者出现4个（2%）推量靶区内失败。2年精算RNC、PC、LRC、DFS和OS率分别为93%、87%、87%、78%和85%。单因素分析显示，腺癌组织学类型与较差的RNC（p=0.02）和OS（p=0.04）相关，而原发肿瘤最大标准化摄取值（SUVmax）与较差的PC（p=0.04）和LRC（p=0.046）相关。≥3级急性及晚期放疗相关毒性发生率分别为2%和4%。采用VMAT联合SIB技术治疗淋巴结阳性LACC可实现安全有效的剂量递增。本中心5年治疗经验表明，该方案疗效优异且未增加额外毒性。
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