Department of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Dr, Singapore 169610, Republic of Singapore.
Int J Gynecol Cancer. 2010 Apr;20(3):428-33. doi: 10.1111/IGC.0b013e3181d4a0d1.
This is a retrospective study evaluating the survival outcomes, patterns of failure, and prognostic factors of chemoradiotherapy incorporating high-dose rate brachytherapy in the treatment of locally advanced cervical cancer.
A review of 120 consecutive patients with Federation Internationale de Gynecologie et d'Obstetrique (FIGO) stages IB2 to IVA cervical cancer treated with concurrent cisplatin-based chemoradiotherapy between April 1999 and January 2005. Overall (OS) and disease-free survival (DFS) were analyzed using the Kaplan-Meier method.
The 5-year OS and DFS rates were, respectively, 65.0% (35.0% IB2, 65.7% IIA-B, 71.0% IIIA-B, and 40.0% IVA) and 57.3% (30.0% IB2, 58.2% IIA-B, 64.0% IIIA-B, and 40.0% IVA). Most patients had squamous cell carcinoma (89.2%) and belonged to FIGO stages IIB (40.8%) and IIIB (30.8%). All but 4 patients completed the planned radiotherapy regimen. There were 48 documented recurrences, of which 13 were locoregional only, 26 were distant only, and 9 were both sites. Five patients (4.2%) experienced late grade 3 to 4 gastrointestinal toxicity. On multivariate analysis, a preradiotherapy hemoglobin level of less than 10 g/dL and tumor size of 4 cm or greater or bulky on computed tomography were independently significant variables for OS, whereas a nadir hemoglobin level of less than 10 g/dL and presence of radiologically enlarged pelvic or paraaortic lymph nodes were independently significant variables for DFS.
We conclude that this regimen is efficacious and feasible, but the safety profile about concurrent administration of high-dose rate brachytherapy and chemotherapy should be studied further. Finally, for cervical cancer patients selected for nonsurgical treatment, radiological assessment of tumor size and lymph node status can provide valuable prognostic information over and above FIGO staging alone.
这是一项回顾性研究，评估了在治疗局部晚期宫颈癌中纳入高剂量率近距离放疗的同期顺铂为基础的放化疗的生存结果、失败模式和预后因素。
对 1999 年 4 月至 2005 年 1 月期间接受同期顺铂为基础的放化疗的 120 例国际妇产科联合会（FIGO）分期为 IB2 至 IVA 期宫颈癌患者进行回顾性分析。采用 Kaplan-Meier 法分析总生存（OS）和无病生存（DFS）。
5 年 OS 和 DFS 率分别为 65.0%（35.0%IB2、65.7%IIA-B、71.0%IIIA-B 和 40.0%IVA）和 57.3%（30.0%IB2、58.2%IIA-B、64.0%IIIA-B 和 40.0%IVA）。大多数患者为鳞状细胞癌（89.2%），FIGO 分期为 IIB（40.8%）和 IIIB（30.8%）。除 4 例患者外，其余患者均完成了计划的放疗方案。有 48 例患者记录到复发，其中 13 例为局部区域复发，26 例为远处转移，9 例为局部区域和远处转移。5 例（4.2%）患者发生 3 至 4 级迟发性胃肠道毒性。多变量分析显示，放疗前血红蛋白水平＜10 g/dL 和肿瘤大小≥4 cm 或 CT 显示肿瘤体积大与 OS 独立相关，而放疗后血红蛋白水平＜10 g/dL 和影像学上盆腔或主动脉旁淋巴结肿大与 DFS 独立相关。
我们得出结论，该方案是有效的且可行的，但应进一步研究高剂量率近距离放疗与化疗同时应用的安全性。最后，对于选择非手术治疗的宫颈癌患者，肿瘤大小和淋巴结状态的影像学评估可以提供比 FIGO 分期更有价值的预后信息。
