外阴鳞癌行同期每周铂类为基础的化疗或每 3-4 周氟尿嘧啶类方案放疗的结局。
Outcomes after radiation therapy with concurrent weekly platinum-based chemotherapy or every-3-4-week 5-fluorouracil-containing regimens for squamous cell carcinoma of the vulva.
机构信息
Harvard Radiation Oncology Program, Boston, MA, USA.
出版信息
Gynecol Oncol. 2011 Jan;120(1):101-7. doi: 10.1016/j.ygyno.2010.09.004. Epub 2010 Oct 14.
OBJECTIVE
To compare outcomes in patients with squamous cell carcinoma (SCC) of the vulva treated with radiation (RT) and concurrent weekly platinum-based or every-3-4-week regimens containing 5-fluorouracil (5-FU).
METHODS
Records of 44 patients with vulvar SCC treated with concurrent chemotherapy and radiation (chemoRT) from 1988 to 2008 were reviewed. Rates of disease-free survival (DFS), overall survival (OS), locoregional recurrence (LRR), and distant metastases (DM) were estimated using the Kaplan-Meier method.
RESULTS
The median age was 63 years (range, 44-90), 84.1% of patients had ECOG performance status 0-1, and patients had FIGO Stage II (n=6), III (n=31), or IVA (n=7) disease. Patients were treated preoperatively (n=10), postoperatively (n=10), or without surgery (n=24). The median RT dose to the vulva was 50.2 Gray (range, 22-75). Concurrent chemotherapy regimens included weekly platinum (n=16) or every 3-4 week regimens with 5-FU as the backbone (n=28). With a median follow-up of 31.5 months, there was no significant difference in 2-year OS (74.5% vs. 70.0%; p=0.65), DFS (61.9% vs. 56.0%; p=0.85), LRR (31.3% vs. 32.9%; p=0.93), or DM (6.3% vs. 10.6%; p=0.81) between the weekly platinum and every-3-4-week 5-FU regimens. Twenty patients (45.4%) recurred: 16 LRR, 2 DM, and 2 with both. The clinical and pathologic complete response rates were 58.8% (20/34), and 53.8% (14/26), respectively. There was a higher proportion of grade 3 or higher acute non-skin toxicities in patients receiving every-3-4-week 5-FU (46.1% vs. 13.3%; p=0.07), but more grade 3 or higher skin toxicity in patients receiving weekly platinum (62.5% vs. 32.0%; p=0.01).
CONCLUSION
OS, response rates, and recurrence rates were not significantly different after RT with concurrent weekly platinum-based versus every-3-4-week regimens containing 5-FU for vulvar SCC.
目的
比较接受放疗（RT）联合每周铂类或每 3-4 周含 5-氟尿嘧啶（5-FU）方案治疗外阴鳞癌（SCC）患者的结局。
方法
回顾了 1988 年至 2008 年期间接受同步化疗和放疗（chemoRT）治疗的 44 例外阴 SCC 患者的记录。采用 Kaplan-Meier 法估计无病生存率（DFS）、总生存率（OS）、局部区域复发率（LRR）和远处转移率（DM）。
结果
中位年龄为 63 岁（范围 44-90），84.1%的患者 ECOG 体能状态 0-1，FIGO 分期为 II 期（n=6）、III 期（n=31）或 IVA 期（n=7）。患者接受术前治疗（n=10）、术后治疗（n=10）或无手术治疗（n=24）。外阴放疗剂量中位数为 50.2Gy（范围 22-75）。同期化疗方案包括每周铂类（n=16）或每 3-4 周含 5-FU 方案（n=28）。中位随访 31.5 个月后，每周铂类组与每 3-4 周 5-FU 组的 2 年 OS（74.5% vs. 70.0%；p=0.65）、DFS（61.9% vs. 56.0%；p=0.85）、LRR（31.3% vs. 32.9%；p=0.93）和 DM（6.3% vs. 10.6%；p=0.81）无显著差异。20 例（45.4%）患者复发：16 例 LRR、2 例 DM 和 2 例同时发生。临床和病理完全缓解率分别为 58.8%（20/34）和 53.8%（14/26）。接受每 3-4 周 5-FU 方案的患者急性非皮肤毒性 3 级或以上比例较高（46.1% vs. 13.3%；p=0.07），而接受每周铂类方案的患者皮肤毒性 3 级或以上比例较高（62.5% vs. 32.0%；p=0.01）。
结论
外阴 SCC 患者接受 RT 联合每周铂类或每 3-4 周含 5-FU 方案治疗后，OS、缓解率和复发率无显著差异。
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