局部晚期宫颈癌治疗的进展：印度钦奈癌症研究所（WIA）的经验

Evolution in the management of locally advanced cervical cancer: the experience of Cancer Institute (WIA), Chennai, India.

作者信息

Shanta V, Selvaluxmy G, Swaminathan R, Shanthi P

机构信息

Cancer Institute (WIA), Department of Gynecology Oncology, Chennai, India.

出版信息

Asian Pac J Cancer Prev. 2010;11(4):1091-8.

PMID:21133630

Abstract

OBJECTIVE

To conduct a retrospective analysis of disease free survival (DFS) of locally advanced cervical cancer (LACC) in relation to evolution of treatment and related factors.

METHODS

A total of 3,892 cases of LACC treated at the Cancer Institute (WIA), Chennai, India, during 1990-1999 were analyzed. Management of LACC including concurrent chemo-radiation (CCRT) has evolved through trials conducted at the institute. DFS and risk of second cancer were elicited using actuarial and Kaplan-Meier methods, respectively.

RESULTS

A majority belonged to stage III (54%) and complete follow-up at 5-years was 90%. DFS at 5, 10 and 15-years were 58%, 49% and 42% for stage IIB and 43%, 35% and 31% for stage III, respectively. External beam radiotherapy (EBRT) alone as treatment modality reported the poorest 5-year DFS (37%). Addition of chemotherapy to EBRT resulted in marginal increase in survival (41%) but inclusion of brachytherapy to EBRT enhanced survival (58%) significantly (p<0.001). CCRT with brachytherapy as a planned component resulted in the best DFS (69%), irrespective of disease stage. In a carefully selected group of patients who were suitable for salvage surgery, the long-term DFS was 71%, 63% and 63% at 5, 10 and 15 years, respectively, for stages IIB and III together. Complete response was achieved in 67% and 15% of them recurred. Remote metastasis occurred in 13%. The cumulative risk of developing any second cancer was 0.5% at 5 years, 1.9% at 10 years and 2.8% at 15 years of follow up.

CONCLUSION

Our data indicates satisfactory treatment outcome even in advanced disease and with the present state of knowledge, the recommended standard treatment for LACC is careful pre-treatment evaluation followed by CCRT which includes brachytherapy.

摘要

目的

对局部晚期宫颈癌（LACC）的无病生存期（DFS）与治疗进展及相关因素进行回顾性分析。

方法

分析了1990 - 1999年期间在印度钦奈癌症研究所（WIA）接受治疗的3892例LACC病例。该研究所通过开展试验，使LACC的治疗管理包括同步放化疗（CCRT）得到了发展。分别采用精算方法和Kaplan - Meier方法得出DFS和二次癌症风险。

结果

大多数患者属于III期（54%），5年的完整随访率为90%。IIB期患者5年、10年和15年的DFS分别为58%、49%和42%，III期患者分别为43%、35%和31%。单纯外照射放疗（EBRT）作为治疗方式的5年DFS最差（37%）。在EBRT基础上加用化疗使生存率略有提高（41%），但在EBRT基础上加入近距离放疗显著提高了生存率（58%）（p<0.001）。以近距离放疗为计划组成部分的CCRT产生了最佳的DFS（69%），与疾病分期无关。在一组经过精心挑选、适合挽救性手术的患者中，IIB期和III期患者联合起来在5年、10年和15年的长期DFS分别为71%、63%和63%。其中67%的患者实现了完全缓解，15%出现复发。13%发生远处转移。随访5年、10年和15年时发生任何二次癌症的累积风险分别为0.5%、1.9%和2.8%。