10. Độc tính phác đồ hóa xạ trị đồng thời kỹ thuật vmat và áp sát 3D ung thư cổ tử cung
Nội dung chính của bài viết
Tóm tắt
Nghiên cứu nhằm mô tả một số độc tính của phác đồ hóa xạ trị đồng thời kỹ thuật xạ VMAT và áp sát 3D ung thư cổ tử cung. Nghiên cứu trên 73 bệnh nhân ung thư cổ tử cung giai đoạn IB3 - IIIC2 (FIGO 2018) điều trị hóa xạ đồng thời với cisplatin kết hợp xạ ngoài VMAT và áp sát 3D. Độc tính cấp và muộn được theo dõi và phân độ theo CTCAE v5.0. Kết quả cho thấy các độc tính cấp chán ăn, buồn nôn, nôn, tiêu chảy, mệt mỏi, mất ngủ, hạ tiểu cầu, tăng men gan, tăng creatinin chủ yếu độ 1, 2. Hạ bạch cầu đa nhân trung tính gặp độ 3, 4 nhưng không gây gián đoạn điều trị. Có mối liên quan giữa một số độc tính cấp với thể tích mô lành nhận xạ. Tỉ lệ độc tính muộn thấp. Xạ trường chiếu mở rộng không làm tăng đáng kể độc tính. Như vậy, độc tính của phác đồ hóa xạ đồng thời kỹ thuật xạ VMAT và áp sát 3D chủ yếu mức độ nhẹ, vừa và có thể kiểm soát được.
Chi tiết bài viết
Từ khóa
Độc tính, hóa xạ đồng thời, xạ điều biến thể tích hình cung (VMAT), xạ áp sát dưới hướng dẫn hình ảnh 3D (3D-IGBT), ung thư cổ tử cung
Tài liệu tham khảo
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15. Toita T, Kitagawa R, Hamano T, et al. Feasibility and acute toxicity of Concurrent Chemoradiotherapy (CCRT) with high-dose rate intracavitary brachytherapy (HDR-ICBT) and 40-mg/m2 weekly cisplatin for Japanese patients with cervical cancer: results of a Multi-Institutional Phase 2 Study (JGOG1066). Int J Gynecol Cancer. 2012; 22(8): 1420-1426. doi:10.1097/IGC.0b013e3182647265.
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21. Pötter R, Tanderup K, Schmid MP, et al. MRI-guided adaptive brachytherapy in locally advanced cervical cancer (EMBRACE-I): a multicentre prospective cohort study. The Lancet Oncology. 2021; 22(4): 538-547. doi:10.1016/S1470-2045(20)30753-1.
2. Nguyen SM, Deppen S, Nguyen GH, Pham DX, Bui TD, Tran TV. Projecting Cancer Incidence for 2025 in the 2 Largest Populated Cities in Vietnam. Cancer Control. 2019; 26(1): 1073274819865274. doi:10.1177/1073274819865274.
3. NCI Urges Chemo-RT Combination for Invasive Cervical Cancer. 1999; 8(4). Accessed August 13, 2022. https://www.cancernetwork.com/view/nci-urges-chemo-rt-combination-invasive-cervical-cancer.
4. Green J, Kirwan J, Tierney J, et al. Concomitant chemotherapy and radiation therapy for cancer of the uterine cervix. Cochrane Database Syst Rev. 2005; (3): CD002225. doi:10.1002/14651858.CD002225.pub2.
5. Ramey SJ, Asher D, Kwon D, et al. Delays in definitive cervical cancer treatment: An analysis of disparities and overall survival impact. Gynecol Oncol. 2018; 149(1): 53-62. doi:10.1016/j.ygyno.2017.12.010.
6. Reducing Uncertainties About the Effects of Chemoradiotherapy for Cervical Cancer: A Systematic Review and Meta-Analysis of Individual Patient Data From 18 Randomized Trials. J Clin Oncol. 2008; 26(35): 5802-5812. doi:10.1200/JCO.2008.16.4368.
7. Mayadev JS, Ke G, Mahantshetty U, Pereira MD, Tarnawski R, Toita T. Global challenges of radiotherapy for the treatment of locally advanced cervical cancer. Int J Gynecol Cancer. 2022; 32(3): 436-445. doi:10.1136/ijgc-2021-003001.
8. Pötter R, Tanderup K, Kirisits C, et al. The EMBRACE II study: The outcome and prospect of two decades of evolution within the GEC-ESTRO GYN working group and the EMBRACE studies. Clin Transl Radiat Oncol. 2018; 9: 48-60. doi:10.1016/j.ctro.2018.01.001.
9. International Commission on Radiation Units and Measurements. Journal of the ICRU. 2013; 13(1-2): NP.2-NP. doi:10.1093/jicru/ndw028.
10. Common Terminology Criteria for Adverse Events (CTCAE). Published online 2017: 155.
11. Otto K. Volumetric modulated arc therapy: IMRT in a single gantry arc. Med Phys. 2008; 35(1): 310-317. doi:10.1118/1.2818738.
12. Seppenwoolde Y, Majercakova K, Buschmann M, et al. Early morbidity and dose–volume effects in definitive radiochemotherapy for locally advanced cervical cancer: a prospective cohort study covering modern treatment techniques. Strahlenther Onkol. 2021; 197(6): 505-519. doi:10.1007/s00066-021-01781-6.
13. Renard-Oldrini S, Guinement L, Salleron J, et al. [Dosimetric comparaison between VMAT and tomotherapy with para-aortic irradiation for cervix carcinoma]. Cancer Radiother. 2015; 19(8): 733-738. doi:10.1016/j.canrad.2015.05.031.
14. Bai W, Kou C, Yu W, et al. Dosimetric comparison of volumetric-modulated arc therapy and intensity-modulated radiation therapy in patients with cervical cancer: a meta-analysis. Onco Targets Ther. 2018; 11: 7179-7186. doi:10.2147/OTT.S178336.
15. Toita T, Kitagawa R, Hamano T, et al. Feasibility and acute toxicity of Concurrent Chemoradiotherapy (CCRT) with high-dose rate intracavitary brachytherapy (HDR-ICBT) and 40-mg/m2 weekly cisplatin for Japanese patients with cervical cancer: results of a Multi-Institutional Phase 2 Study (JGOG1066). Int J Gynecol Cancer. 2012; 22(8): 1420-1426. doi:10.1097/IGC.0b013e3182647265.
16. Ikushima H, Osaki K, Furutani S, et al. Chemoradiation therapy for cervical cancer: toxicity of concurrent weekly cisplatin. Radiat Med. 2006; 24(2): 115-121. doi:10.1007/BF02493277.
17. Zhou P, Zhang Y, Luo S, Zhang S. Pelvic bone marrow sparing radiotherapy for cervical cancer: A systematic review and meta-analysis. Radiother Oncol. 2021; 165: 103-118. doi:10.1016/j.radonc.2021.10.015.
18. Kumar T, Schernberg A, Busato F, et al. Correlation between pelvic bone marrow radiation dose and acute hematological toxicity in cervical cancer patients treated with concurrent chemoradiation. Cancer Manag Res. 2019; 11: 6285-6297. doi:10.2147/CMAR.S195989.
19. Huang X, Fang M, Zhu L, et al. Clinical Observation of Prophylactic Extended-Field Intensity-Modulated Radiation Therapy with Synchronous Chemotherapy in Locally Advanced Cervical Cancer. Med Sci Monit. 2021; 27: e930457. doi:10.12659/MSM.930457.
20. Reijtenbagh DMW, Godart J, Mens JWM, Heijkoop ST, Heemsbergen WD, Hoogeman MS. Patient-reported acute GI symptoms in locally advanced cervical cancer patients correlate with rectal dose. Radiotherapy and Oncology. 2020; 148: 38-43. doi:10.1016/j.radonc.2020.03.035.
21. Pötter R, Tanderup K, Schmid MP, et al. MRI-guided adaptive brachytherapy in locally advanced cervical cancer (EMBRACE-I): a multicentre prospective cohort study. The Lancet Oncology. 2021; 22(4): 538-547. doi:10.1016/S1470-2045(20)30753-1.