Green J A, Kirwan J M, Tierney J F, Symonds P, Fresco L, Collingwood M, Williams C J
Department of Medicine, University of Liverpool, L69 3GA, Liverpool, UK.
Lancet. 2001 Sep 8;358(9284):781-6. doi: 10.1016/S0140-6736(01)05965-7.
The US National Cancer Institute alert in February, 1999, stated that concomitant chemotherapy and radiotherapy should be considered for all patients with cervical cancer. Our aim was to review the effects of chemoradiotherapy on overall and progression-free survival, local and distant control, and acute and late toxicity in patients with cervical cancer.
With the methodology of the Cochrane Collaboration, we did a systematic review of all known randomised controlled trials done between 1981 and 2000 (17 published, two unpublished) of chemoradiation for cervical cancer.
The trials included 4580 randomised patients, and 2865-3611 patients (62-78%) were available for analysis. Cisplatin was the most common agent used. The findings suggest that chemoradiation improves overall survival (hazard ratio 0.71, p<0.0001), whether platinum was used (0.70, p<0.0001) or not (0.81, p=0.20). A greater beneficial effect was seen in trials that included a high proportion of stage I and II patients (p=0.009). An improvement in progression-free survival was also seen with chemoradiation (0.61, p<0.0001). Thus, the absolute benefit in progression-free and overall survival was 16% (95% CI 13-19) and 12% (8-16), respectively. A significant benefit of chemoradiation on both local (odds ratio 0.61, p<0.0001) and distant recurrence (0.57, p<0.0001) was also recorded. Grade 3 or 4 haematological (odds ratio 1.49-8.60) and gastrointestinal (2.22) toxicities were significantly greater in the concomitant chemoradiation group than the control group. There was insufficient data to establish whether late toxicity was increased in the concomitant chemoradiation group.
Concomitant chemotherapy and radiotherapy improves overall and progression-free survival and reduces local and distant recurrence in selected patients with cervical cancer, which may give a cytotoxic and sensitisation effect.
1999年2月美国国立癌症研究所发布警报称，所有宫颈癌患者均应考虑同步放化疗。我们的目的是回顾同步放化疗对宫颈癌患者总生存期和无进展生存期、局部和远处控制以及急性和晚期毒性的影响。
采用Cochrane协作网的方法，我们对1981年至2000年间进行的所有已知的宫颈癌放化疗随机对照试验（17项已发表，2项未发表）进行了系统评价。
这些试验纳入了4580例随机分组的患者，其中2865 - 3611例患者（62% - 78%）可用于分析。顺铂是最常用的药物。结果表明，无论是否使用铂类药物，同步放化疗均可提高总生存期（风险比0.71，p<0.0001；使用铂类药物时为0.70，p<0.0001；未使用铂类药物时为0.81，p = 0.20）。在纳入I期和II期患者比例较高的试验中观察到更大的有益效果（p = 0.009）。同步放化疗也可改善无进展生存期（0.61，p<0.0001）。因此，无进展生存期和总生存期的绝对获益分别为16%（95%CI 13 - 19）和12%（8 - 16）。同步放化疗对局部复发（优势比0.61，p<0.0001）和远处复发（0.57，p<0.0001）均有显著益处。同步放化疗组3级或4级血液学毒性（优势比1.49 - 8.60）和胃肠道毒性（2.22）显著高于对照组。没有足够的数据来确定同步放化疗组的晚期毒性是否增加。
同步放化疗可提高特定宫颈癌患者的总生存期和无进展生存期，并减少局部和远处复发，这可能具有细胞毒性和增敏作用。
