Loizzi V, Cormio G, Loverro G, Selvaggi L, Disaia P J, Cappuccini F
Department of Obstetrics and Gynecology, University of Bari, Bari, Italy.
Int J Gynecol Cancer. 2003 Sep-Oct;13(5):580-6. doi: 10.1046/j.1525-1438.2003.13378.x.
Despite advances in screening, cervical cancer remains a major health problem worldwide. In an effort to improve loco-regional control, both neoadjuvant and chemoradiation have been trialed. Recently, five randomized clinical trials performed by the Gynecologic Oncology Group, the Radiation Therapy Oncology Group and the Southwest Oncology Group have demonstrated a significant advantage both in progression-free and overall survival when cisplatin-based chemotherapy was administered during radiation for advanced stages of cervical cancer. Based on the results of these trials, the US National Cancer Institute released a Clinical Announcement supporting the concurrent use of cisplatin-based chemotherapy with radiation therapy for high-risk early stage and locally advanced stage cervical cancer. Subsequently, an additional prospective randomized trial performed by the National Cancer Institute of Canada was not able to show benefit with the use of chemoradiation compared with radiation alone for patients with locally advanced stage cervical cancer. This article will analyze these six clinical trials in order to determine the role of chemoradiation in the management of patients with cervical cancer. Furthermore, as anemia is one of the most powerful prognostic factors in patients with cervical cancer, we propose to evaluate the relationship between a decreased level of hemoglobin and treatment outcome.
尽管在筛查方面取得了进展，但宫颈癌仍是全球主要的健康问题。为了提高局部区域控制率，新辅助治疗和放化疗都已进行了试验。最近，妇科肿瘤学组、放射肿瘤学组和西南肿瘤学组进行的五项随机临床试验表明，在宫颈癌晚期放疗期间给予顺铂为基础的化疗，在无进展生存期和总生存期方面均具有显著优势。基于这些试验结果，美国国立癌症研究所发布了一项临床声明，支持在高危早期和局部晚期宫颈癌中同时使用顺铂为基础的化疗与放射治疗。随后，加拿大国立癌症研究所进行的另一项前瞻性随机试验未能显示，对于局部晚期宫颈癌患者，与单纯放疗相比，放化疗有何益处。本文将分析这六项临床试验，以确定放化疗在宫颈癌患者管理中的作用。此外，由于贫血是宫颈癌患者最有力的预后因素之一，我们建议评估血红蛋白水平降低与治疗结果之间的关系。
