Eifel Patricia J
The University of Texas MD Anderson Cancer Center, Department of Radiation Oncology, 1515 Holcombe Boulevard, Unit 1202, Houston, TX 77030, USA.
Nat Clin Pract Oncol. 2006 May;3(5):248-55. doi: 10.1038/ncponc0486.
From 1999-2000, each of five randomized trials demonstrated improved rates of survival and local control when concurrent cisplatin-based chemotherapy was added to radiation therapy in patients with loco-regionally advanced cervical cancer. These studies demonstrated that addition of chemotherapy to radiation therapy improved the outcome of patients treated with radiation therapy and hysterectomy or radiation therapy alone. Although concurrent chemotherapy increases the severity of acute side effects, it does not appear to increase the risk of late side effects of radiation therapy. A sixth randomized trial, published in 2002, failed to demonstrate improved outcome with concurrent weekly cisplatin over radiation therapy alone; however, the earlier trials demonstrated benefit with this chemoradiation regimen. In addition, three of the earlier randomized trials demonstrated improved outcome with combinations of cisplatin and 5-fluorouracil compared with radiation therapy alone. Although cisplatin-based chemoradiation is the most accepted standard, individual trials have suggested that other drugs, including mitomycin and epirubicin, might be beneficial. Randomized trials that investigated the administration of neoadjuvant chemotherapy before radiation therapy have failed to demonstrate a benefit of this approach. Although the evidence for benefit of concurrent chemotherapy is strong for otherwise healthy patients with newly diagnosed, loco-regionally advanced cervical cancers confined to the pelvis, the relative benefits and risks are not well understood for patients who are infirm or who require larger fields of radiation therapy. In such patients, the theoretical benefits and potential risks should be considered carefully before a treatment plan is prescribed.
从1999年至2000年，五项随机试验中的每一项都表明，对于局部晚期宫颈癌患者，在放疗中加入以顺铂为基础的同步化疗可提高生存率和局部控制率。这些研究表明，在放疗基础上加用化疗可改善单纯接受放疗和子宫切除术或单纯放疗患者的治疗效果。虽然同步化疗会增加急性副作用的严重程度，但似乎不会增加放疗晚期副作用的风险。2002年发表的第六项随机试验未能证明每周同步使用顺铂比单纯放疗能改善治疗效果；然而，早期试验表明这种放化疗方案是有益的。此外，早期的三项随机试验表明，与单纯放疗相比，顺铂和5-氟尿嘧啶联合使用可改善治疗效果。虽然以顺铂为基础的放化疗是最被认可的标准，但个别试验表明，包括丝裂霉素和表柔比星在内的其他药物可能也有益处。研究放疗前新辅助化疗给药的随机试验未能证明这种方法有好处。虽然对于新诊断的、局限于盆腔的局部晚期宫颈癌且身体状况 otherwise healthy 的患者，同步化疗有益的证据很充分，但对于体弱或需要更大放疗野的患者，其相对益处和风险尚不完全清楚。在此类患者中，在制定治疗方案之前应仔细考虑理论上的益处和潜在风险。
