Background: This study aims to evaluate patients with locally advanced cervical cancer who underwent definitive radiochemotherapy, including brachytherapy, at the University Hospital of Muenster (UKM), focusing on target volume coverage, oncologic outcome parameters, and organs at risk (OAR) toxicities. Results are compared with the Gyn GEC-ESTRO (GGE) recommendations. Methods: Of a cohort of 48 patients, treated between 2013 and 2023, the physical radiation treatment planning with application of CT and MRI and oncologic follow-up data was analyzed. Target volume structures, comprising the high-risk clinical target volume (HR-CTV), intermediate-risk clinical target volume (IR-CTV), Point A, and corresponding EQD2(α/β=10)doses were determined. Endpoints included local tumor control, overall survival (OS), recurrence-free survival (RFS), and progression-free survival (PFS). Total OAR (D2cc) EQD2(α/β=3)doses were correlated with adverse events defined by CTCAE v5.0 and LENT-SOMA criteria. Results: Median follow-up was 58.0 months (95% CI [27.6, 88.4]). FIGO stage I was present in 7 (15%) patients, II in 13 (27%), and III in 28 (58%) patients. A total of 38 (79%) patients showed a complete remission 3 months after treatment. The 5-year event-free rate was 67.4% (95% CI [49.3, 80.3]) for OS, 77.0% (95% CI [56.7, 88.6]) for RFS and 68.1% (95% CI [49.7, 80.9]) for PFS. Incomplete radiation treatment and advanced tumor stages led to worse outcomes. Meeting Point A GGE recommendations increased chances for complete remission and could decrease chances of an event occurring for OS, PFS, and RFS. Compliance with GGE recommendations lowered the chances of OAR toxicity occurring. Conclusions: MRI-based target volume definition for brachytherapy in cervical cancer may improve patients’ OS, PFS, and RFS. Time-to-event endpoints are consistent with comparable studies, and adherence to current ESGO/ESTRO/ESP guidelines is endorsed.
背景：本研究旨在评估明斯特大学医院（UKM）接受根治性放化疗（包括近距离放疗）的局部晚期宫颈癌患者，重点关注靶区覆盖、肿瘤学结局参数以及危及器官（OAR）毒性。研究结果与妇科GEC-ESTRO（GGE）推荐标准进行比较。方法：对2013年至2023年间接受治疗的48例患者队列，分析其基于CT和MRI的物理放射治疗计划及肿瘤学随访数据。确定靶区结构，包括高风险临床靶区（HR-CTV）、中风险临床靶区（IR-CTV）、A点及相应的EQD2(α/β=10)剂量。观察终点包括局部肿瘤控制、总生存期（OS）、无复发生存期（RFS）和无进展生存期（PFS）。总OAR（D2cc）EQD2(α/β=3)剂量与CTCAE v5.0和LENT-SOMA标准定义的不良事件进行相关性分析。结果：中位随访时间为58.0个月（95% CI [27.6, 88.4]）。FIGO分期I期7例（15%），II期13例（27%），III期28例（58%）。共38例（79%）患者在治疗后3个月达到完全缓解。5年无事件率OS为67.4%（95% CI [49.3, 80.3]），RFS为77.0%（95% CI [56.7, 88.6]），PFS为68.1%（95% CI [49.7, 80.9]）。不完整的放射治疗和晚期肿瘤分期导致更差的结局。达到A点GGE推荐标准可提高完全缓解几率，并可能降低OS、PFS和RFS的事件发生风险。遵循GGE推荐标准降低了OAR毒性发生几率。结论：基于MRI的宫颈癌近距离放疗靶区定义可能改善患者的OS、PFS和RFS。事件发生时间终点与同类研究结果一致，支持遵循现行ESGO/ESTRO/ESP指南。
肿瘤(癌症)患者之家