Royal Perth Hospital, Department of Radiation Oncology, Perth, Western Australia.
Int J Radiat Oncol Biol Phys. 2012 Mar 15;82(4):1431-8. doi: 10.1016/j.ijrobp.2011.04.047. Epub 2011 Jun 2.
A retrospective review of patients with Stage IB1-IVA cervical cancer treated with combined chemoradiotherapy in Western Australia was conducted with the aim of assessing outcomes and patterns of recurrence. Multivariate analysis was performed to identify potential prognostic factors.
Patients treated with radical chemoradiotherapy for cervical cancer in Western Australia between June 2005 and November 2008 were analyzed. Treatment consisted of external-beam radiotherapy with concurrent weekly cisplatin (40 mg/m(2)), followed by high-dose-rate brachytherapy. The Kaplan-Meier method was used to determine overall survival and disease-free survival, and Cox regression analysis was used to identify potential prognostic factors.
Sixty-nine patients were included in the analysis. All patients completed external-beam radiotherapy; however, only 43.5% of patients completed the planned course of brachytherapy. At a median follow-up of 27 months, 24- and 48-month overall survival were 68.8% and 61.1%, respectively. Disease-free survival at 24 and 48 months was 59.4% and 56.7%, respectively. The 2-year local control rate was 70.1%. Nodal involvement resulted in increased risk of disease recurrence (hazard ratio [HR] 6.26, p = 0.002) and death (HR 5.15, p = 0.013). Pretreatment hemoglobin <120 g/L was a negative prognostic factor for disease recurrence (HR 4.20, p = 0.031) and death (HR 8.19, p = 0.020). Completion of brachytherapy improved overall survival (p = 0.039), with a trend to reducing disease recurrence (p = 0.052). The risk of relapse increased with treatment time over 8 weeks (HR 8.18, p = 0.019), however treatment time did not affect the risk of death (p = 0.245).
The overall survival outcomes in this group of women with locally advanced cervical carcinomas treated with chemoradiotherapy are comparable to worldwide data. Despite the use of modern treatment protocols, a significant proportion of women developed locoregional recurrences and distant failures. Many poor prognostic factors have been identified as contributors to this, including pelvic nodal involvement, incomplete brachytherapy, pretreatment hemoglobin <120 g/L, and treatment time over 8 weeks.
对在澳大利亚西部接受联合放化疗的 IB1-IVA 期宫颈癌患者进行回顾性分析，旨在评估其治疗结果和复发模式。通过多变量分析确定潜在的预后因素。
分析了 2005 年 6 月至 2008 年 11 月期间在澳大利亚西部接受根治性放化疗的宫颈癌患者。治疗包括外照射放疗联合每周顺铂（40mg/m2），随后进行高剂量率近距离放疗。采用 Kaplan-Meier 法计算总生存率和无病生存率，采用Cox 回归分析确定潜在的预后因素。
共有 69 例患者纳入分析。所有患者均完成了外照射放疗；但只有 43.5%的患者完成了计划的近距离放疗疗程。中位随访 27 个月时，24 个月和 48 个月的总生存率分别为 68.8%和 61.1%。24 个月和 48 个月的无病生存率分别为 59.4%和 56.7%。2 年局部控制率为 70.1%。淋巴结受累增加了疾病复发（风险比 [HR] 6.26，p=0.002）和死亡（HR 5.15，p=0.013）的风险。治疗前血红蛋白<120g/L 是疾病复发（HR 4.20，p=0.031）和死亡（HR 8.19，p=0.020）的不良预后因素。完成近距离放疗可改善总生存率（p=0.039），并降低疾病复发的趋势（p=0.052）。治疗时间超过 8 周时，复发风险增加（HR 8.18，p=0.019），但治疗时间对死亡风险无影响（p=0.245）。
接受放化疗的局部晚期宫颈癌患者的总体生存结果与全球数据相当。尽管采用了现代治疗方案，但仍有相当一部分患者发生局部区域复发和远处转移失败。许多不良预后因素导致了这一结果，包括盆腔淋巴结受累、近距离放疗不完全、治疗前血红蛋白<120g/L 和治疗时间超过 8 周。
