Einhorn Nina, Tropé Claes, Ridderheim Mona, Boman Karin, Sorbe Bengt, Cavallin-Ståhl Eva
Department of Oncology, Karolinska Hospital, Stockholm, Sweden.
Acta Oncol. 2003;42(5-6):546-56. doi: 10.1080/02841860310014660.
A systematic review of radiation therapy trials in several tumour types was performed by The Swedish Council of Technology Assessment in Health Care (SBU). The procedures for evaluation of the scientific literature are described separately (Acta Oncol 2003; 42: 357-365). This synthesis of the literature on radiation therapy for cervical cancer is based on data from 1 meta-analysis and 34 randomized trials. In total, 35 scientific articles are included, involving 7 952 patients. The results were compared with those of a similar overview from 1996 including 34 024 patients. The conclusions reached can be summarized in these points: There are limited scientific data supporting that postoperative pelvic radiotherapy improves disease-free survival in early cervical cancer. No firm conclusion can be drawn. There is moderate scientific evidence that external beam radiotherapy combined with brachytherapy gives a similar disease-free and overall survival rate as radical hysterectomy in early cervical cancer. There is strong scientific evidence that concomitant radiochemotherapy improves disease-free and overall survival compared to radiotherapy alone in early cervical cancer. The NCI has recently published an announcement stating that cisplatin-based chemotherapy should be used concomitantly with radiotherapy in cervical cancer. No solid documentation for this statement can be found concerning locally advanced stages ( >IIB). There is a strong scientific evidence that cisplatin-based chemotherapy given concomitantly with radiotherapy is superior to concomitant chemotherapy with hydroxyurea. There is no scientific evidence to show that neoadjuvant chemotherapy followed by radiotherapy improves disease-free or overall survival compared to radiotherapy alone in patients with localized cervical cancer. There is moderate scientific evidence that high-dose-rate brachytherapy gives the same local control rate as low-dose-rate brachytherapy but with fewer rectal complications.
瑞典医疗技术评估委员会（SBU）对多种肿瘤类型的放射治疗试验进行了系统评价。科学文献的评估程序已另行描述（《肿瘤学学报》2003年；42：357 - 365）。本关于宫颈癌放射治疗的文献综述基于1项荟萃分析和34项随机试验的数据。总共纳入35篇科学文章，涉及7952例患者。将结果与1996年的一项类似综述（涉及34024例患者）的结果进行了比较。得出的结论可总结如下：支持术后盆腔放疗可提高早期宫颈癌无病生存率的科学数据有限，无法得出确切结论。有中等科学证据表明，外照射放疗联合近距离放疗在早期宫颈癌中的无病生存率和总生存率与根治性子宫切除术相似。有强有力的科学证据表明，与单纯放疗相比，同步放化疗可提高早期宫颈癌的无病生存率和总生存率。美国国立癌症研究所（NCI）最近发布公告称，宫颈癌放疗应同时使用以顺铂为基础的化疗。但对于局部晚期阶段（>IIB），未找到关于此声明的确凿证据。有强有力的科学证据表明，放疗同时给予以顺铂为基础的化疗优于同时给予羟基脲化疗。没有科学证据表明，与单纯放疗相比，局部宫颈癌患者新辅助化疗后再放疗可提高无病生存率或总生存率。有中等科学证据表明，高剂量率近距离放疗与低剂量率近距离放疗的局部控制率相同，但直肠并发症较少。
