Franckena Martine, Lutgens Ludy C, Koper Peter C, Kleynen Catharina E, van der Steen-Banasik Elsbieta M, Jobsen Jan J, Leer Jan Willem, Creutzberg Carien L, Dielwart Michel F, van Norden Yvette, Canters Richard A M, van Rhoon Gerard C, van der Zee Jacoba
Department of Radiation Oncology, Erasmus Medical Center, Rotterdam, The Netherlands.
Int J Radiat Oncol Biol Phys. 2009 Jan 1;73(1):242-50. doi: 10.1016/j.ijrobp.2008.03.072. Epub 2008 Nov 5.
To report response rate, pelvic tumor control, survival, and late toxicity after treatment with combined radiotherapy and hyperthermia (RHT) for patients with locally advanced cervical carcinoma (LACC) and compare the results with other published series.
From 1996 to 2005, a total of 378 patients with LACC (International Federation of Gynecology and Obstetrics Stage IB2-IVA) were treated with RHT. External beam radiotherapy (RT) was applied to 46-50.4 Gy and combined with brachytherapy. The hyperthermia (HT) was prescribed once weekly. Primary end points were complete response (CR) and local control. Secondary end points were overall survival, disease-specific survival, and late toxicity. Patient, tumor, and treatment characteristics predictive for the end points were identified in univariate and multivariate analyses.
Overall, a CR was achieved in 77% of patients. At 5 years, local control, disease-specific survival, and incidence of late toxicity Common Terminology Criteria for Adverse Events Grade 3 or higher were 53%, 47%, and 12%, respectively. In multivariate analysis, number of HT treatments emerged as a predictor of outcome in addition to commonly identified prognostic factors.
The CR, local control, and survival rates are similar to previously observed results of RHT in the randomized Dutch Deep Hyperthermia Trial. Reported treatment results for currently applied combined treatment modalities (i.e., RT with chemotherapy and/or HT) do not permit definite conclusions about which combination is superior. The present results confirm previously shown beneficial effects from adding HT to RT and justify the application of RHT as first-line treatment in patients with LACC as an alternative to chemoradiation.
报告局部晚期宫颈癌（LACC）患者接受放疗联合热疗（RHT）后的缓解率、盆腔肿瘤控制情况、生存率及晚期毒性反应，并将结果与其他已发表系列进行比较。
1996年至2005年，共有378例LACC患者（国际妇产科联盟分期为IB2-IVA期）接受了RHT治疗。外照射放疗（RT）剂量为46-50.4 Gy，并联合近距离放疗。热疗（HT）每周进行一次。主要终点为完全缓解（CR）和局部控制。次要终点为总生存、疾病特异性生存和晚期毒性反应。通过单因素和多因素分析确定对各终点有预测作用的患者、肿瘤及治疗特征。
总体而言，77%的患者实现了CR。5年时，局部控制率、疾病特异性生存率以及不良事件通用术语标准3级或更高等级的晚期毒性反应发生率分别为53%、47%和12%。在多因素分析中，除了常见的预后因素外，热疗治疗次数成为结果的一个预测因素。
CR率、局部控制率和生存率与荷兰深部热疗随机试验中先前观察到的RHT结果相似。目前应用的联合治疗模式（即放疗联合化疗和/或热疗）的报道治疗结果无法就哪种联合方式更优得出明确结论。本研究结果证实了先前显示的热疗联合放疗的有益效果，并证明RHT作为LACC患者一线治疗替代放化疗的应用是合理的。
