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Figure 1: FDG-PET/CT를 활용한 target volume delineation (gross tumor volume: orange; clinical target volume: sky blue; bladder: yellow; rectum: green)​

Figure 2: 87명 환자의 치료 성적 (OS: overall survival, LC: local control, PFS: progression free survival) - 3년 국소종양제어율 89.2% (95% confidence interval [CI], 80.3–94.2%), 3년 무병생존율은 72.1% (95% CI, 61.3–80.4%), 3년 생존율은 84.7% (CI, 75.1–90.8%)을 보여주었다.​

Abstract

The aim of the study was to evaluate the treatment outcomes in cervical cancer patients treated with 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT)-guided 3-dimensional brachytherapy (3D-BT) planning for the first brachytherapy session.We retrospectively analyzed 87 patients with cervical cancer who received definitive radiotherapy (RT). Primary tumor size was ≤4 cm in 22 patients (25.3%), >4 cm and ≤6 cm in 45 patients (51.7%), and >6 cm in 20 patients (23.0%). The median total dose of external beam RT was 50.4 (50.4-60.4) Gy. FDG-PET/CT-guided 3D-BT with an iridium-192 source was performed. The clinical target volume (CTV) for 3D-BT included the entire cervix and the abnormal FDG-uptake with a 1-cm expansion. A planned total dose was 24 Gy at 4 Gy per insertion 3 times per week using a tandem and 2 ovoids.The mean D95 and D90 for the CTV were 73.4 (±5.9) Gy and 77.9 (±6.9) Gy, respectively (EQD2, α/β=10). The D2cc for the rectum and bladder was 374 (±97.4) cGy and 394 (±107.6) cGy per fraction, respectively. The EQD2 (α/β=3) for the D2cc was 74.5 (±12.4) Gy for the rectum and 77.3 (±14.6) Gy for the bladder. The median follow-up period was 40 (8-61) months. The 3-year overall survival (OS), progression-free survival (PFS), and local control (LC) rates were 84.7%, 72.1%, and 89.2%, respectively. The 3-year LC rate was 100% for tumors ≤ 4 cm, 91.1% for tumors > 4 cm and ≤ 6 cm, and 70.5% for tumors > 6 cm (P = 0.014). Local failure developed in 9 patients. Three patients had local failures outside of the CTV. Grade 1, 2, and 3 rectal bleeding developed in 5, 4, and 2 patients, respectively. One patient experienced rectovaginal fistula.FDG-PET/CT-guided 3D-BT planning is a feasible approach, which showed favorable clinical outcomes. 

Author information​

Oh D1, Huh SJ, Park W, Ju SG, Nam H, Lee JE.

1aDepartment of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea bDepartment of Radiation Oncology, Kangbuk Samsung Hospital, Seoul, Korea cDepartment of Radiation Oncology, Kyungpook National University School of Medicine, Daegu, Korea.