Tian Zhong-ze, Li Sha, Liu Ming-lu, Zhu Xiang-hui, Zhao Rui, Yue Yang-jun, Chen Xiao-hua
Department of Radiation Oncology, Lanzhou Command General Hospital, Lanzhou, China.
Zhonghua Fu Chan Ke Za Zhi. 2010 Jul;45(7):506-10.
To investigate the long-term curative effect of the radiotherapy combined uterine arterial interventional chemoembolization for cervical cancer.
Records of 632 patients with cervical cancer stage II - IVa proved by pathology in Lanzhou Command General Hospital from January 1st, 1999 to August 31st, 2009 were retrospective analysed. One hundred and twenty-six cases of them were treated with radical radiotherapy combined uterine arterial interventional chemoembolization (arterial chemoembolization + radiotherapy group), 506 cases of them were treated with radical radiotherapy only (radiotherapy group); the evaluation of the late radiation injury was done, according to Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer (RTOG/EORTC) advanced radiation injury criteria. Prognosis and complications were compared between two groups, relative risk factors of radiotherapy complications were identified by method of logistic regression.
(1) Survival: the total survival rates of 1-year, 2-year, 5-year and 8-year were 94.4%, 82.3%, 48.8%, 29.1%, respectively. The survival rates of arterial chemoembolization + radiotherapy group were 96.0%, 82.1%, 37.2%, 25.7%, while the survival rates of radiotherapy group were 94.1%, 80.8%, 51.1%, 31.5%, in which there were significant differences between two groups (χ(2) = 0.009, P = 0.993; χ(2) = 0.158, P = 0.691; χ(2) = 11.197, P = 0.001;χ(2) = 9.649, P = 0.002). During the follow-up period, the rate of recurrence and metastasis in arterial chemoembolization + radiotherapy group were 77.0% (97/126), while 73.3% (371/506) in radiotherapy group (χ(2) = 0.705, P = 0.401). (2) Radiotherapy complications and relative risk factors: the total incidence of tardive bladder injury higher than RTOG/EORTC stage II was 5.5% (35/632), while it was 11.1% (14/126) in arterial chemoembolization + radiotherapy group, 4.2% (21/506) in the radiotherapy group (χ(2) = 9.344, P = 0.002). The results of logistic regression showed that the uterine arterial interventional chemoembolization was relative risk factors of the tardive bladder injury (χ(2) = 6.440, OR = 2.869, P = 0.011).
Compared with the simple radiotherapy, there are a similar short-term survival rate and significant poor 5-year, 8-year survival rate in the patients treated with the uterine arterial interventional chemoembolization combined with radiotherapy, which also may be strong dangerous factor for the occurrence of tardive bladder injury. The results shown that the uterine arterial interventional chemoembolization do not recommend to be routine adjuvant therapy for the radical radiotherapy of cervical cancer.
探讨放疗联合子宫动脉介入化疗栓塞术治疗宫颈癌的远期疗效。
回顾性分析1999年1月1日至2009年8月31日兰州军区总医院收治的632例经病理证实为Ⅱ - Ⅳa期宫颈癌患者的病历资料。其中126例采用根治性放疗联合子宫动脉介入化疗栓塞术（动脉化疗栓塞 + 放疗组），506例仅采用根治性放疗（放疗组）；根据放射治疗肿瘤学组/欧洲癌症研究与治疗组织（RTOG/EORTC）晚期放射损伤标准对晚期放射损伤进行评估。比较两组患者的预后及并发症情况，采用logistic回归方法分析放疗并发症的相关危险因素。
（1）生存情况：1年、2年、5年和8年总生存率分别为94.4%、82.3%、48.8%、29.1%。动脉化疗栓塞 + 放疗组生存率分别为96.0%、82.1%、37.2%、25.7%，放疗组生存率分别为94.1%、80.8%、51.1%、31.5%，两组间差异有统计学意义（χ(2)=0.009，P = 0.993；χ(²)=0.158，P = 0.691；χ(²)=11.197，P = 0.001；χ(²)=9.649，P = 0.002）。随访期间，动脉化疗栓塞 + 放疗组复发转移率为77.0%（97/126），放疗组为则73.3%（371/506）（χ(²)=0.705，P = 0.401）。（2）放疗并发症及相关危险因素：迟发性膀胱损伤高于RTOG/EORTC Ⅱ级的总发生率为5.5%（35/632），动脉化疗栓塞 + 放疗组为11.1%（14/126），放疗组为4.2%（21/506）（χ(²)=9.344,P = 0.002）。logistic回归分析结果显示子宫动脉介入化疗栓塞术是迟发性膀胱损伤的相关危险因素（χ(²)=6.440，OR = 2.869，P = 0.011）。
与单纯放疗相比，子宫动脉介入化疗栓塞术联合放疗患者短期生存率相近，但5年、8年生存率明显较差，且可能是迟发性膀胱损伤发生的高危因素。结果表明子宫动脉介入化疗栓塞术不推荐作为宫颈癌根治性放疗的常规辅助治疗。
