Jones Ellen L, Samulski Thaddeus V, Dewhirst Mark W, Alvarez-Secord Angeles, Berchuck Andrew, Clarke-Pearson Daniel, Havrilesky Laura J, Soper John, Prosnitz Leonard R
Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina 27710, USA.
Cancer. 2003 Jul 15;98(2):277-82. doi: 10.1002/cncr.11475.
Five randomized studies have demonstrated a benefit derived from adding cisplatin (CDDP)-based chemotherapy to radiotherapy (RT) for treatment of cervical carcinoma. The Dutch Phase III pelvic tumor trial demonstrated a survival and local control benefit due to the addition of hyperthermia (HT) to RT. The authors evaluated response and toxicity in patients with locally advanced cervical carcinoma (LACC) who were treated with concurrent weekly CDDP, HT, and RT (whole pelvis [n=7] and whole pelvis and paraaortic nodes [n=5]).
From August 1998 through December 2000, 12 patients with LACC or locally recurrent cervical carcinoma (LRCC) following hysterectomy were enrolled on a pilot study combining weekly CDDP, HT, and RT.
Ten patients were treated at initial diagnosis. All achieved clinical complete response and durable local control. Two of the 10 experienced recurrence outside the pelvis; 1 of these patients had pulmonary metastasis, and the other had isolated paraaortic nodal involvement. Two patients treated for LRCC experienced local and systemic progression and died of disease within 6 months.
In this small series, trimodality therapy resulted in an excellent clinical response and was well tolerated. The addition of HT to chemoradiotherapy represents a promising new strategy that warrants multiinstitutional collaborative efforts to confirm its efficacy.
五项随机研究表明，在宫颈癌治疗中，在放疗（RT）基础上加用顺铂（CDDP）为基础的化疗可带来益处。荷兰的III期盆腔肿瘤试验表明，放疗加用热疗（HT）可提高生存率并改善局部控制。作者评估了局部晚期宫颈癌（LACC）患者接受每周一次同步CDDP、HT和RT（全盆腔放疗[n = 7]以及全盆腔加腹主动脉旁淋巴结放疗[n = 5]）治疗后的反应和毒性。
从1998年8月至2000年12月，12例子宫切除术后的LACC或局部复发性宫颈癌（LRCC）患者参加了一项每周同步进行CDDP、HT和RT的试点研究。
10例患者在初次诊断时接受治疗。所有患者均实现临床完全缓解和持久的局部控制。10例中有2例在盆腔外复发；其中1例有肺转移，另1例有孤立的腹主动脉旁淋巴结受累。2例接受LRCC治疗的患者出现局部和全身进展，并在6个月内死于疾病。
在这个小系列研究中，三联疗法产生了出色的临床反应，且耐受性良好。在放化疗中加用HT是一种有前景的新策略，值得多机构合作以确认其疗效。
