Abu-Rustum N R, Lee S, Correa A, Massad L S
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cook County Hospital, Chicago, Illinois 60612, USA.
Gynecol Oncol. 2001 Apr;81(1):88-91. doi: 10.1006/gyno.2000.6109.
The goals of this work were to describe the compliance with and acute hematologic toxic effects of chemoradiation for cervical cancer in indigent women and to explore the likelihood that chemoradiation is effective outside research settings. We hypothesized that if compliance and toxicity are not limiting in this high-risk group of patients, the effectiveness of chemoradiation for cervical cancer in community settings is likely to mirror the efficacy demonstrated in clinical trials.
This study is a retrospective review of prospectively maintained data on women with newly diagnosed cervical cancer treated with chemoradiation between August 1998 and August 2000. Cisplatin was given weekly at 40 mg/m(2) to a maximum of six courses. A WBC count <3000/mm(3) resulted in cancellation of cisplatin but not radiation, and patients were transfused for hemoglobin <9 g/dl. Statistical analysis was performed using the t test, chi(2) test, and Fisher's exact test.
In all, 19 of 65 patients treated (29.2%) missed at least one chemotherapy cycle, with 10 (15.4%) due to missed appointments, 8 (12.3%) due to a low WBC count, and 1 due to increased creatinine. Nineteen patients (29.2%) received RBC transfusion during chemoradiation, and two (3%) had platelets <75,000/mm(3). Noncompliant patients had a lower mean total point A dose (7986 cGy vs 8413 cGy, P = 0.04) and longer overall treatment duration (79 days vs 51 days, P < 0.001). No patient had a fatal hematologic complication.
Nearly a third of the indigent women treated with chemoradiation for cervical cancer do not complete the prescribed treatment, and a similar number require blood transfusions. In indigent and minority women, the effectiveness of chemoradiation protocols may not mirror the efficacy obtained in clinical trials.
本研究的目的是描述贫困妇女宫颈癌放化疗的依从性和急性血液学毒性作用，并探讨放化疗在研究环境之外有效的可能性。我们假设，如果在这一高危患者群体中依从性和毒性不是限制因素，那么社区环境中宫颈癌放化疗的有效性可能与临床试验中所证明的疗效相似。
本研究是一项回顾性研究，对1998年8月至2000年8月期间接受放化疗的新诊断宫颈癌女性的前瞻性维护数据进行回顾。顺铂每周以40mg/m²给药，最多六个疗程。白细胞计数<3000/mm³会导致顺铂治疗取消，但不影响放疗，血红蛋白<9g/dl的患者会接受输血治疗。使用t检验、卡方检验和Fisher精确检验进行统计分析。
总共65例接受治疗的患者中有19例（29.2%）至少错过一个化疗周期，其中10例（15.4%）是由于错过预约，8例（12.3%）是由于白细胞计数低，1例是由于肌酐升高。19例患者（29.2%）在放化疗期间接受了红细胞输血，2例（3%）血小板计数<75,000/mm³。不依从的患者平均总A点剂量较低（7986cGy对8413cGy，P=0.04），总治疗持续时间较长（79天对51天，P<0.001）。没有患者发生致命的血液学并发症。
近三分之一接受宫颈癌放化疗的贫困妇女未完成规定治疗，且有相似比例的患者需要输血。在贫困和少数族裔妇女中，放化疗方案的有效性可能无法反映临床试验中所获得的疗效。
