Department of Radiation and Cellular Oncology, The University of Chicago Medical Center, Chicago, Illinois 60637, USA.
Cancer. 2013 Jan 15;119(2):325-31. doi: 10.1002/cncr.27652. Epub 2012 Jul 17.
This study sought to determine if treatment time impacts pelvic failure (PF), distant failure (DF), or disease-specific mortality (DSM) in patients undergoing concurrent chemoradiotherapy (CCRT).
A retrospective review was performed of 113 consecutive eligible patients with stage IB2 to IIIB cervical cancer. All patients received whole-pelvis radiation with concurrent chemotherapy and consolidative intracavitary brachytherapy (BT) to the cervix, followed by an external beam parametrial boost when appropriate. The effect of treatment time on PF, DF, and DSM was examined with univariate and multivariate analyses. Characteristics of patients with and without treatment prolongation were compared to explore reasons for treatment prolongation.
The median time to completion of BT was 60 days, and the median time to complete all RT was 68 days. The 3-year cumulative incidence of PF, DF, and DSM were 18%, 23%, and 26%, respectively. On multivariate analysis, time to completion of BT >56 days was associated with increased PF (hazard ratio, 3.8; 95% confidence interval, 1.2-16; P = .02). The 3-year PF for >56 days versus ≤56 days was 26% versus 9% (P = .04). Treatment time was not associated with DF or DSM. Treatment prolongation was found to be associated with delay in starting BT and higher incidence of acute grade 3/4 toxicities.
In the setting of CCRT, treatment time >56 days is detrimental to pelvic control but is not associated with an increase in DF or DSM. To maximize pelvic control, we recommend completing BT in 8 weeks or less.
本研究旨在确定接受同期放化疗（CCRT）的患者的治疗时间是否会影响骨盆失败（PF）、远处失败（DF）或疾病特异性死亡率（DSM）。
对 113 例连续符合条件的 IB2 至 IIIB 期宫颈癌患者进行回顾性分析。所有患者均接受全骨盆放疗联合同期化疗和宫颈腔内近距离放疗（BT）巩固治疗，当适当时行外部束宫旁加量。使用单变量和多变量分析检查治疗时间对 PF、DF 和 DSM 的影响。比较有和无治疗延长的患者的特征，以探讨治疗延长的原因。
BT 完成的中位时间为 60 天，所有 RT 完成的中位时间为 68 天。PF、DF 和 DSM 的 3 年累积发生率分别为 18%、23%和 26%。多变量分析显示，BT 完成时间>56 天与 PF 增加相关（风险比，3.8；95%置信区间，1.2-16；P =.02）。>56 天与≤56 天的 3 年 PF 发生率分别为 26%和 9%（P =.04）。治疗时间与 DF 或 DSM 无关。治疗延长与 BT 开始延迟和急性 3/4 级毒性发生率增加有关。
在 CCRT 环境中，治疗时间>56 天对骨盆控制有害，但与 DF 或 DSM 增加无关。为了最大限度地提高骨盆控制，我们建议在 8 周内完成 BT。
