为了检验对于子宫颈癌患者的局部区域治疗的益处，本研究调查了具有腔内外扩展的子宫颈癌患者接受图片引导自适应腔内放疗（IGABT）的密集治疗。本研究分析了连续接受外部束辐射治疗（EBRT）和IGABT增益治疗作为一线治疗的转移性子宫颈癌患者的医疗记录。根据肿瘤部位，患者接受盆腔+/-腹主动脉EBRT。对于有内脏或上膈淋巴结转移的患者，在通常进行3个化疗周期后，进行放化疗。所有患者均接受磁共振成像引导的腔内放疗增益治疗，并旨在增加对高风险临床靶区（CTVHR）的剂量。研究了局部控制情况、患者整体生存（OS）、无进展生存（PFS）和放疗相关副作用，并寻找预后因素。共纳入164例患者，76.2%为腹主动脉淋巴结扩展而无远处转移（N2），23.8%在远处有转移灶（M1）。两组存活率没有统计学显著差异。随访中位数为36个月，3年时的OS、PFS和LC分别为55.5% （CI95%: 48-64）、40.6%（CI95%: 38-54）和90%（CI95%: 85-96）。多因素分析中，D90CTVHR剂量≥80Gy与更好的OS显著相关（HR=0.96, 95%CI: 0.94-0.98, p<0.001）。大部分毒性反应轻度至中度，有2%的3级迟发性尿路毒性，7%的2级迟发性阴道后遗症和一例3级直肠炎。在随访期间，有两例患者出现直肠阴道瘘，但没有局部复发。IGABT可以增加剂量并获得较高的局部控制率，研究显示了剂量与生存之间的关系。由于远程转移频率较高，系统加强治疗在这些患者中需要进行更具体的探索。 版权所有 © 2023. Elsevier Inc. 发布。

To examine the benefit of an intensive locoregional treatment including an image-guided adaptive brachytherapy (IGABT) among cervical cancer patients with extrapelvic extension.Medical records of consecutive patients with a metastatic cervical cancer and receiving an external beam radiotherapy (EBRT) and IGABT boost in XXXXXX XXXXXX as part of their first line of treatment were examined. Depending on tumor sites, patients received a pelvic +/- para-aortic EBRT. For those with visceral or supradiaphragmatic lymph node metastases, chemoradiation was delivered after usually 3 cycles of chemotherapy. All patients received a brachytherapy boost, guided by magnetic resonance imaging and aimed at increasing the dose to the high risk clinical target volume (CTVHR). Local control, patient overall (OS), progression-free (PFS) survival and radiotherapy-related side effects were examined and prognostic factors were searched.164 patients were included, 76.2% had para-aortic lymph node extension without distant metastasis (N2) and 23.8% had distant metastatic sites (M1). There was not statistically significant difference in survival between both groups. With a median follow-up of 36 months, OS, PFS, and LC at 3 years were 55.5% (CI95%: 48-64), 40.6% (CI95%: 38-54), and 90% (CI95%: 85-96), respectively. In multivariate analysis, a D90CTVHR dose ≥80 Gy was significant for better OS (HR=0.96, 95%CI: 0.94-0.98, p<0.001). Most toxicities were mild to moderate, with 2% of grade 3 late urinary toxicity, 7% late grade 2 vaginal sequelae, and one grade 3 proctitis. During follow-up, rectovaginal fistula occurred in two patients without local relapse.IGABT permits dose escalation and high LC rates for cervical cancer patients with extrapelvic extension. Dose/effect relationships for survival were shown. Because of high frequency of distant events, systemic intensification should be tested more specifically among these patients.Copyright © 2023. Published by Elsevier Inc.