Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA 02115, USA.
Int J Gynecol Cancer. 2009 Nov;19(8):1402-6. doi: 10.1111/IGC.0b013e3181b62e73.
To evaluate factors affecting survival and toxicity in patients with stage IIIB cervical cancer treated with external-beam radiotherapy and low-dose-rate brachytherapy.
Seventy patients with stage IIIB cervical cancer treated between 1980 and 2000 were identified. A total of 51 patients had a tandem placed; 19 had interstitial brachytherapy only with no tandem placed. Univariate and multivariate analyses assessed factors potentially associated with survival and long-term complications.
Kaplan-Meier estimates for overall survival (OS) for the entire population at 2, 3, and 4 years were 43%, 29%, and 27%, respectively. Overall survival differed significantly between those treated with a tandem versus those treated without (log rank P < 0.0001). Significant predictors of OS on univariate Cox regression were presence of a tandem (hazards ratio [HR], 0.31; P = 0.0001) and cumulative dose to point A (HR, 0.95; P = 0.0001). Multivariate regression showed that the presence of a tandem was the only significant predictor of OS (HR, 0.46; P = 0.04). There were no significant predictors of complications.
The dose to point A of approximately 85 Gy as associated with tandem use was a significant predictor of survival in patients with stage IIIB cervical carcinoma, indicating the significance of the central location of the high dose provided by the tandem. Patients selected for interstitial brachytherapy alone must receive sufficient dose, and a tandem should be placed whenever feasible for all patients with an intact uterus treated for locally advanced cervical cancer.
评估接受外照射放疗和低剂量率近距离放疗的 IIIB 期宫颈癌患者的生存和毒性的影响因素。
1980 年至 2000 年间，确定了 70 名 IIIB 期宫颈癌患者。共 51 例放置了子宫托；19 例仅进行了间质近距离放疗，未放置子宫托。单因素和多因素分析评估了与生存和长期并发症相关的潜在因素。
Kaplan-Meier 估计整个人群的总生存率（OS）在 2、3 和 4 年分别为 43%、29%和 27%。接受子宫托治疗的患者与未接受子宫托治疗的患者之间的总生存率有显著差异（对数秩检验，P <0.0001）。单因素 Cox 回归分析显示，OS 的显著预测因素是存在子宫托（风险比[HR]，0.31；P = 0.0001）和 A 点累积剂量（HR，0.95；P = 0.0001）。多因素回归显示，子宫托的存在是 OS 的唯一显著预测因素（HR，0.46；P = 0.04）。并发症无显著预测因素。
与使用子宫托相关的 A 点剂量约为 85 Gy 是 IIIB 期宫颈癌患者生存的显著预测因素，表明子宫托提供的高剂量中央位置的重要性。选择单独进行间质近距离放疗的患者必须接受足够的剂量，对于所有接受局部晚期宫颈癌治疗的完整子宫患者，只要可行，都应放置子宫托。
