Department of Radiology, Saitama Cancer Center, Saitama, Japan.
Int J Gynecol Cancer. 2011 Nov;21(8):1465-71. doi: 10.1097/IGC.0b013e318226f657.
Extended-field radiotherapy (EFRT) with the concomitant administration of chemotherapy for patients with advanced cervical cancer has problems regarding its feasibility. The goal of the present study was to assess the tolerability and control rate of low-dose cisplatin with EFRT in patients with imaging-confirmed positive para-aortic lymph nodes (PALs).
Sixteen patients with cervical cancer metastatic to the PALs treated with EFRT were evaluated. The patients included those with stages I to III disease according to the International Federation of Gynecology and Obstetrics with positive PALs diagnosed by computed tomographic imaging. The patients were treated with 25 to 30 mg/m weekly of cisplatin concurrently with radiation therapy. Doses of 48.6 to 51.0 Gy were delivered in 1.8-Gy fractions to the pelvis and included the PALs field. In addition, boost doses for the involved nodes of PALs were delivered contiguously for a total dose of 54 to 60 Gy. All patients were treated with a high dose rate of intracavitary brachytherapy combined with external irradiation.
All patients completed the radiation therapy. Grade 3 or 4 acute hematologic toxicity occurred in 7 patients, but there were no cases of grade 3 or 4 nonhematologic acute toxicity. As a late toxicity, 1 patient developed a grade 3 small bowel obstruction. No grade 4 or worse late toxicity occurred. The 4-year overall survival rate was 56.3%. The 4-year distant metastasis-free survival rate was 50%. Seven patients had no recurrence. Eight patients developed distant failures, and another had an isolated local intrapelvic recurrence.
A dose greater than 54 Gy for positive PALs in EFRT, in combination with intracavitary irradiation and low-dose weekly cisplatin administration, was safely completed by all of our patients. However, half of the patients had distant failure. This study provided relatively favorable local control and survival. Further considering modifications of the treatment should therefore be encouraged.
对于晚期宫颈癌患者，采用扩展野放疗（EFRT）并同时给予化疗存在可行性问题。本研究旨在评估在影像学证实阳性的腹主动脉旁淋巴结（PALs）患者中，低剂量顺铂联合 EFRT 的耐受性和控制率。
对 16 例接受 EFRT 治疗的 PALs 转移宫颈癌患者进行评估。这些患者为国际妇产科联合会（FIGO）分期 I 至 III 期疾病，且通过计算机断层扫描成像诊断为 PALs 阳性。患者每周接受 25 至 30mg/m2 的顺铂同步放疗。盆腔和 PALs 野分别给予 48.6 至 51.0Gy 的剂量，分割剂量为 1.8Gy。此外，为了使 PALs 受累淋巴结获得总剂量 54 至 60Gy，对其进行了连续的局部加量照射。所有患者均采用高剂量率腔内近距离放疗联合外部照射进行治疗。
所有患者均完成了放疗。7 例患者发生 3 或 4 级急性血液学毒性，但无 3 或 4 级非血液学急性毒性病例。作为晚期毒性，1 例患者发生 3 级小肠梗阻。无 4 级或更高级别的晚期毒性。4 年总生存率为 56.3%。4 年无远处转移生存率为 50%。7 例患者无复发。8 例患者发生远处转移失败，另 1 例患者出现孤立性盆腔内局部复发。
在 EFRT 中，对于阳性 PALs，给予大于 54Gy 的剂量，联合腔内照射和低剂量每周顺铂给药，所有患者均安全完成。然而，半数患者发生远处转移失败。本研究提供了相对有利的局部控制和生存。因此，应鼓励进一步考虑治疗方案的修改。
