Ozsaran Z, Yalman D, Yürüt V, Aras A, Ozsaran A, Hanhan M, Haydaroğlu A
Ege University Faculty of Medicine, Department of Radiation Oncology, Izmir, Turkey.
Eur J Gynaecol Oncol. 2003;24(2):191-4.
Radiotherapy is the standard treatment for locally advanced cervical cancer. Recent results of the prospective randomized trials have shown an overall survival and local control advantage for cisplatin-based therapy given concurrently with radiation therapy. Thirty-nine patients who received concurrent chemoradiation between October 1999 and December 2000 were evaluated for treatment response, local control and toxicity.
Thirty-nine patients with Stage IB through IVA cervical carcinoma received weekly cisplatin (40 mg/m2) concurrent with radiotherapy. Thirty-two patients received both external and intracavitary radiotherapy and seven patients received only external radiotherapy because of insufficient tumor response for intracavitary application. Total external radiotherapy dose was 64.8 Gy with 1.8 Gy daily fractions in patients who received only external radiotherapy. Midline shielding was performed at 50.4 Gy in patients who were going to receive brachytherapy and the total external radiotherapy dose was 54-59.4 Gy. Brachytherapy was performed with a Rotterdam applicator via the microSelectron HDR machine. A total dose of 8.5-18 Gy was applied to point A.
Median age was 55. Distribution by stages were as follows: Stage IB 5.1%, IIA 28.2%, IIB 43.6%, IIIA 7.7%, IIIB 12.8% and IVA 2.6%. Histologically 33 (84.6%) were epidermoid carcinoma, one was adenocarcinoma, two were undifferentiated carcinoma, one was malignant epithelial tumor. In two patients histological type could not be specified. The median duration of follow-up was 20 months. Four patients had local recurrence and three developed distant metastases. Thirty patients (76.9%) had complete response, eight had (20.5%) partial response and one had (2.6%) stable disease. During or after radiochemotherapy 46.2% of the patients developed toxicity due to chemotherapy. Early and late radiation morbidity rates were 66.7% and 71.8%, respectively. No grade III-IV toxicity was observed.
Concurrent chemoradiation for locally advanced cervical cancer is the treatment of choice in suitable patients providing high response rates with acceptable toxicity.
放射治疗是局部晚期宫颈癌的标准治疗方法。前瞻性随机试验的近期结果显示，顺铂为基础的治疗与放射治疗同时进行，在总生存期和局部控制方面具有优势。对1999年10月至2000年12月期间接受同步放化疗的39例患者进行了治疗反应、局部控制和毒性评估。
39例IB期至IVA期宫颈癌患者每周接受顺铂（40mg/m²）同步放疗。32例患者接受了体外和腔内放疗，7例患者因肿瘤对腔内放疗反应不足仅接受了体外放疗。仅接受体外放疗的患者体外放疗总剂量为64.8Gy，每日分次剂量为1.8Gy。准备接受近距离放疗的患者在50.4Gy时进行中线屏蔽，体外放疗总剂量为54 - 59.4Gy。通过microSelectron HDR机器使用鹿特丹施源器进行近距离放疗。A点总剂量为8.5 - 18Gy。
中位年龄为55岁。各分期分布如下：IB期5.1%，IIA期28.2%，IIB期43.6%，IIIA期7.7%，IIIB期12.8%，IVA期2.6%。组织学上，33例（84.6%）为鳞状细胞癌，1例为腺癌，2例为未分化癌，1例为恶性上皮肿瘤。2例患者组织学类型无法明确。中位随访时间为20个月。4例患者出现局部复发，3例发生远处转移。30例（76.9%）患者完全缓解，8例（20.5%）部分缓解，1例（2.6%）病情稳定。放化疗期间或之后，46.2%的患者因化疗出现毒性反应。早期和晚期放射并发症发生率分别为66.7%和71.8%。未观察到III - IV级毒性反应。
对于局部晚期宫颈癌，同步放化疗是合适患者的首选治疗方法，可提供高缓解率且毒性可接受。
