Spensley S, Hunter R D, Livsey J E, Swindell R, Davidson S E
Department of Clinical Oncology, Christie Hospital, Manchester, UK.
Clin Oncol (R Coll Radiol). 2009 Feb;21(1):49-55. doi: 10.1016/j.clon.2008.10.014. Epub 2008 Dec 11.
Two recent meta-analyses have shown a survival advantage for the addition of concurrent chemotherapy to radiotherapy in the treatment of cervical cancer. However, there is insufficient information available on late toxicity and few data from UK practice. The aims of this study were to examine treatment outcomes (survival and toxicity) in patients with cervical cancer treated with chemoradiation and to compare these with outcomes in patients treated with radiation alone.
Between July 2000 and December 2003, 75 patients with cervical cancer were treated with chemoradiation. Case notes were reviewed retrospectively. Acute and late toxicity were recorded, with late toxicity graded using the Franco-Italian glossary. The median age was 47 years. All patients were staged with examination under anaesthesia and magnetic resonance imaging scans. Forty-two patients were treated with concurrent chemoradiation alone and 33 patients were treated with a combination of neoadjuvant and concurrent chemoradiation. This was due to waiting list problems. The chemotherapy used was cisplatin 40 mg/m(2) weekly with radiotherapy, (the neoadjuvant dose was 60 mg/m(2) 3 weekly). External beam radiotherapy was given to the pelvis (40-45 Gy/20 fractions/4 weeks) followed by low dose rate brachytherapy (22.5-32.5 Gy to point A). Patients who were unable to have brachytherapy were given an external beam boost (15-20 Gy/8-10 fractions).
The 3-year overall survival rate was 70%, with an estimated 5-year overall survival rate of 60%. The 3-year disease-free survival was 63.6%, with an estimated 5-year disease-free survival rate of 55%. Compared with the cohort of 183 patients from the Christie Hospital in a 1993 audit, there was a trend towards improved overall survival from 49 to 60% (P=0.06), which may become significant with longer follow-up. There were seven patients (9.3%) with grade 3 toxicity and no cases of grade 4 toxicity. In comparison with patients treated in the 1993 audit, the late toxicity rate has increased from 3.4 to 9.3%, but this was not statistically significant (P=0.14).
There was a trend towards improved survival with concurrent chemoradiation in this cohort of patients that may become significant with longer follow-up.
最近两项荟萃分析表明，在宫颈癌治疗中，同步放化疗可提高生存率。然而，关于晚期毒性的信息不足，且英国实践中的数据较少。本研究的目的是检查接受放化疗的宫颈癌患者的治疗结果（生存率和毒性），并将其与单纯接受放疗的患者的结果进行比较。
2000年7月至2003年12月期间，75例宫颈癌患者接受了放化疗。回顾性查阅病历。记录急性和晚期毒性，晚期毒性采用法意词汇表进行分级。中位年龄为47岁。所有患者均在麻醉下检查和磁共振成像扫描进行分期。42例患者仅接受同步放化疗，33例患者接受新辅助化疗和同步放化疗联合治疗。这是由于等待名单问题。所用化疗方案为顺铂40mg/m²每周一次联合放疗，（新辅助剂量为60mg/m²每3周一次）。盆腔给予外照射放疗（40 - 45Gy/20次/4周），随后给予低剂量率近距离放疗（A点剂量为22.5 - 32.5Gy）。无法进行近距离放疗的患者给予外照射增敏（15 - 20Gy/8 - 10次）。
3年总生存率为70%，估计5年总生存率为60%。3年无病生存率为63.6%，估计5年无病生存率为55%。与1993年一项审计中来自克里斯蒂医院的183例患者队列相比，总生存率有从49%提高到60%的趋势（P = 0.06），随着随访时间延长可能会变得显著。有7例患者（9.3%）出现3级毒性，无4级毒性病例。与1993年审计中治疗的患者相比，晚期毒性率从3.4%增加到9.3%，但无统计学意义（P = 0.14）。
在该队列患者中，同步放化疗有提高生存率的趋势，随着随访时间延长可能会变得显著。
