Department of Procreative Medicine, Division of Gynecology and Obstetrics, University of Pisa, Italy.
Anticancer Res. 2010 Sep;30(9):3731-5.
To review a tailored treatment with concurrent chemoradiotherapy (CT/RT) or neoadjuvant chemotherapy (NACT) followed by radical hysterectomy in locally advanced cervical cancer.
One hundred and four patients were treated with a tailored therapeutic approach. CT/RT was the standard treatment for patients with stage Ib2-IIb disease aged more than 70 years, or with high surgical risk, as well as for those with stage III-IV disease. NACT followed by radical hysterectomy was the treatment of choice for patients with stage Ib(2)-IIb disease, maximum age of 70 years and good performance status.
For the 61 women who underwent CT/RT, 5-year disease-free (DFS) survival and 5-year overall survival (OS) were 62% and 71%, respectively. Patient outcome was associated with the clinical response to CT/RT (complete responders versus others: 5-year DFS, 81% versus 19%, p<0.001; 5-year OS, 84% versus 37%, p=0.001). For the 43 women who underwent NACT, 5-year DFS and 5-year OS were 66% and 75%, respectively. Patient outcome was associated with the pathological response to chemotherapy (optimal responders versus others: 5-year DFS, 89% versus 62%, p=0.03; 5-year OS, 90% versus 72%, p=0.05).
Tailored treatments obtained satisfactory clinical outcomes in locally advanced cervical cancer. Optimal pathological response to NACT has been found to be a surrogate endpoint of OS. The identification of biological variables able to predict response to NACT is strongly warranted for an accurate selection of patients who may really benefit from chemosurgical treatment.
回顾局部晚期宫颈癌采用同步放化疗（CT/RT）或新辅助化疗（NACT）联合根治性子宫切除术的个体化治疗。
104 例患者采用个体化治疗方法。CT/RT 是 70 岁以上 Ib2-IIb 期、高危手术或 III-IV 期患者的标准治疗方法。NACT 后行根治性子宫切除术是 Ib(2)-IIb 期、最大年龄 70 岁、一般状况良好患者的首选治疗方法。
61 例行 CT/RT 的患者 5 年无病生存（DFS）率和 5 年总生存（OS）率分别为 62%和 71%。患者的预后与 CT/RT 的临床疗效相关（完全缓解者与其他患者相比：5 年 DFS 率为 81%与 19%，p<0.001；5 年 OS 率为 84%与 37%，p=0.001）。43 例行 NACT 的患者 5 年 DFS 和 5 年 OS 率分别为 66%和 75%。患者的预后与化疗的病理疗效相关（完全缓解者与其他患者相比：5 年 DFS 率为 89%与 62%，p=0.03；5 年 OS 率为 90%与 72%，p=0.05）。
局部晚期宫颈癌的个体化治疗获得了满意的临床结果。NACT 的最佳病理缓解已被发现是 OS 的替代终点。确定能够预测 NACT 反应的生物学变量对于准确选择可能真正受益于化疗手术的患者具有重要意义。
