Fyles A, Keane T J, Barton M, Simm J
Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Canada.
Radiother Oncol. 1992 Dec;25(4):273-9. doi: 10.1016/0167-8140(92)90247-r.
A significant effect of treatment duration on pelvic control was found in 830 patients with cervix cancer treated by radical radiation therapy. Using three methods of analysis, the loss of control consistently approximated 1% per day of treatment prolongation beyond 30 days, although analysis of stage subgroups showed that this effect was predominantly manifested in Stages III/IV compared with Stages I/II. In multivariate analyses using both a logistic regression and a Cox regression model, stage (p = 0.0001 for Stage I/IIA and 0.0036 for Stage IIB relative to Stage III/IV) treatment time (p = 0.0001), and age (p = 0.0067) were independently correlated with pelvic control. Exclusion from analysis of patients with delays due to tumour or treatment related complications, intercurrent illness or manifestations of poor tumour response did not significantly change the magnitude of the time effect nor the ranking of the significant covariates. These results are consistent with the occurrence of accelerated repopulation and warrant further investigation, preferably in a randomized trial of accelerated versus conventionally fractionated radiation therapy.
在830例接受根治性放射治疗的宫颈癌患者中，发现治疗时长对盆腔控制有显著影响。采用三种分析方法，治疗超过30天后，控制丧失率持续约为每天1%，不过对分期亚组的分析表明，与I/II期相比，这种影响主要表现在III/IV期。在使用逻辑回归和Cox回归模型的多变量分析中，分期（I/IIA期相对于III/IV期，p = 0.0001；IIB期相对于III/IV期，p = 0.0036）、治疗时间（p = 0.0001）和年龄（p = 0.0067）与盆腔控制独立相关。排除因肿瘤或治疗相关并发症、并发疾病或肿瘤反应不佳表现而导致延误的患者后进行分析，时间效应的大小和显著协变量的排名均未发生显著变化。这些结果与加速再增殖的发生情况一致，值得进一步研究，最好在加速放疗与常规分割放疗的随机试验中进行。
