98: Concomitant Hypofractionated Imrt Boost for Localized High-Risk Prostate Cancer: Five Year Results of a Prospective Trial
Notice bibliographique
Résumé
Purpose: To compare the combined intracavitary/interstitial brachytherapy (IC/IS) with intracavitary brachytherapy alone (IC) in cervical cancer treated with definitive radiochemotherapy and MRI guided adaptive brachytherapy (BT) within the EMBRACE study and the impact on target dose, OAR dose and late morbidity. Methods and Materials:The EMBRACE database containing 1129 cervix cancer patients enrolled in the study with treatment completed before 09/2014 was used for this study.Patients having a MRI based parametrial infiltration status (PI) at time of BT (n = 999) were divided according to their PI status at first BT: no PI (456 patients), proximal PI (412 patients) and distal + pelvic wall PI (122 patients).Patients in each group were compared according to the use of IC or IC/IS during the course of their treatment, to dose in the HRCTV, OARs, and to late morbidity.T-test was performed on target and OAR doses (all EQD2 with α/β of 10 and 3 Gy) and Chi-square test was performed on patients' characteristics variables.Univariate analysis of morbidity Grade 2 and more (G2≤) (rectum, bladder, bowel, vagina, overall morbidity) was performed with actuarial probabilities based on Kaplan-Meier statistics.Results: The median follow up was 23 and 26 months for the IC/IS and IC group, respectively.IC/IS patients with proximal PI had significantly less G2≥ bladder (19% versus 28%, p = 0.014), bowel (10% versus 22%, p = 0.002) and overall morbidity (51% versus 68%, p = 0.003) at three years, but no difference in G2 ≥ rectal and vaginal morbidity.A significant dose decrease was found for bowel D2cm 3 in the IC/IS group in comparison to the IC group (61 ± 8 Gy versus 63 ± 10Gy) while the same mean dose (D90) to the HRCTV was given.Rectal and bladder D2cm 3 was not significantly different.Patients with distal or pelvic wall PI experienced less rectal (13% versus 46%, p = 0.001) and bowel (13% versus 40%, p = 0.054) morbidity G2≥ at three years in the IC/IS group in comparison to the IC group while bladder and vaginal toxicities were not significantly different.Patients in the IS/IC group received a significantly higher HR CTV D90 (87 ± 9 Gy versus 80 ± 13 Gy, p < 0.001).Conclusions: These results demonstrate that regardless of the extent of PI, the dosimetric and clinical advantages of combined intracavitary/interstitial brachytherapy compared to intracavitary brachytherapy alone are substantial.IC/IS brachytherapy allows for a significantly higher HRCTV D90 (7Gy) in patients with distal and pelvic wall PI than IC brachytherapy while leading to less rectal and bowel morbidity.For patients with proximal PI, the use of IC/IS brachytherapy was associated with less bladder, bowel and overall morbidity while allowing for the same target dose.Potential biases induced by treatment related factors still have to be addressed in a multivariate analysis.A more systematic use of IC/IS brachytherapy in cervix cancer patients with PI is therefore recommended, especially for OAR sparing and for increase of dose to the HRCTV.98
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,003 | 0,004 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,002 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,003 | 0,004 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,006 | 0,002 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».