Torres Mylin A, Jhingran Anuja, Thames Howard D, Levenback Charles F, Bodurka Diane C, Ramondetta Lois M, Eifel Patricia J
Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
Int J Radiat Oncol Biol Phys. 2008 Jan 1;70(1):118-25. doi: 10.1016/j.ijrobp.2007.05.028. Epub 2007 Sep 14.
To compare the treatment and outcomes of cervical cancer patients treated with concurrent chemoradiotherapy (CT-RT) in a multi-institutional trial or as standard care.
We reviewed the records of 302 patients treated with CT-RT for locoregionally confined, intact cervical cancer between 1990 and 2005. Of the 302 patients, 76 were treated using cisplatin and 5-fluorouracil (C/F) on Radiation Therapy Oncology Group protocol 90-01 (CT-RT(90-01)); 226 underwent CT-RT as standard care with either C/F [CT-RT(SC(C/F)); n = 115] or weekly cisplatin [CT-RT(SC(WC)); n = 111).
The CT-RT(90-01) patients more often had tumors >or=6 cm and were less often diabetic than were the CT-RT(SC) patients. The CT-RT(SC(WC)) patients were more likely than the CT-RT(SC(C/F)) patients to be >or=60 years old or to have Stage III-IV disease. During treatment, CT-RT(SC(C/F)) patients experienced more Grade 2-3 neutropenia and were, therefore, less likely to receive 200 mg/m(2) cisplatin than were either CT-RT(SC(WC)) or CT-RT(90-01) patients (52% vs. 77% vs. 85%, respectively; p <0.001). At 5 years, the disease-specific survival rates were greater for patients treated with C/F [CT-RT(SC(C/F)), 75%; CT-RT(90-01), 79%] than for those treated with CT-RT(SC(WC)) (58%; p = 0.02). On multivariate analysis, C/F chemotherapy, cisplatin dose >or=200 mg/m(2), Stage I-II disease, and negative pelvic lymph nodes were independent predictors of improved disease-specific survival.
Even within a large comprehensive cancer center, the high rates of chemotherapy completion achieved on a multi-institutional trial can be difficult to reproduce in standard practice. Although C/F toxicity was greater in the standard care patients, their outcomes were similar to those of patients treated with C/F on Radiation Therapy Oncology Group protocol 90-01.
在一项多机构试验或作为标准治疗中，比较接受同步放化疗（CT-RT）的宫颈癌患者的治疗情况和结局。
我们回顾了1990年至2005年间302例接受CT-RT治疗的局部区域局限、宫颈完整的宫颈癌患者的记录。在这302例患者中，76例按照放射肿瘤学组90-01方案使用顺铂和5-氟尿嘧啶（C/F）进行治疗（CT-RT(90-01)）；226例作为标准治疗接受CT-RT，其中使用C/F的有[CT-RT(SC(C/F))；n = 115]，使用每周一次顺铂的有[CT-RT(SC(WC))；n = 111]。
与CT-RT(SC)患者相比，CT-RT(90-01)患者肿瘤≥6 cm的情况更常见，糖尿病患者更少。与CT-RT(SC(C/F))患者相比，CT-RT(SC(WC))患者年龄≥60岁或患有III-IV期疾病的可能性更大。在治疗期间，CT-RT(SC(C/F))患者出现2-3级中性粒细胞减少的情况更多，因此接受200 mg/m²顺铂治疗的可能性低于CT-RT(SC(WC))或CT-RT(90-01)患者（分别为52%、77%和85%；p <0.001）。5年时，接受C/F治疗的患者[CT-RT(SC(C/F))，75%；CT-RT(90-01)，79%]的疾病特异性生存率高于接受CT-RT(SC(WC))治疗的患者（58%；p = 0.02）。多因素分析显示，C/F化疗、顺铂剂量≥200 mg/m²、I-II期疾病以及盆腔淋巴结阴性是疾病特异性生存率提高的独立预测因素。
即使在大型综合癌症中心，多机构试验中实现的高化疗完成率在标准实践中也难以重现。虽然标准治疗患者的C/F毒性更大，但他们的结局与按照放射肿瘤学组90-01方案接受C/F治疗的患者相似。
