Harvard Radiation Oncology Program, Harvard Medical School, Boston, Massachusetts, United States of America.
PLoS One. 2013 Jun 7;8(6):e65048. doi: 10.1371/journal.pone.0065048. Print 2013.
It is not known whether the addition of chemotherapy to radiation therapy improves outcomes in primary vaginal cancer. Here, we review clinical outcomes in patients with primary vaginal cancer treated with radiation therapy (RT) or concurrent chemoradiation therapy (CRT).
Seventy-one patients with primary vaginal cancer treated with definitive RT with or without concurrent chemotherapy at a single institution were identified and their records reviewed. A total of 51 patients were treated with RT alone; 20 patients were treated with CRT. Recurrences were analyzed. Overall survival (OS) and disease-free survival (DFS) rates were estimated using the Kaplan-Meier method. Cox regression analysis was performed.
The median age at diagnosis was 61 years (range, 18-92 years) and the median follow-up time among survivors was 3.0 years. Kaplan-Meier estimates for OS and DFS differed significantly between the RT and CRT groups (3-yr OS = 56% vs. 79%, log-rank p = 0.037; 3-yr DFS = 43% vs. 73%, log-rank p = 0.011). Twenty-three patients (45%) in the RT group had a relapse at any site compared to 3 (15%) in the CRT group (p = 0.027). With regard to the sites of first relapse, 10 patients (14%) had local only, 4 (6%) had local and regional, 9 (13%) had regional only, 1 (1%) had regional and distant, and 2 (3%) had distant only relapse. On univariate analysis, the use of concurrent chemotherapy, FIGO stage, tumor size, and date of diagnosis were significant predictors of DFS. On multivariate analysis, the use of concurrent chemotherapy remained a significant predictor of DFS (hazard ratio 0.31 (95% CI, 0.10-0.97; p = 0.04)).
Vaginal cancer results in poor outcomes. Adequate radiation dose is essential to ensure curative management. Concurrent chemotherapy should be considered for vaginal cancer patients.
目前尚不清楚在原发性阴道癌中添加化疗是否能改善治疗结果。在此，我们回顾了在单一机构接受放射治疗（RT）或同期放化疗（CRT）治疗的原发性阴道癌患者的临床结果。
在一家机构中，共确定了 71 例接受根治性 RT 治疗且无同步化疗的原发性阴道癌患者，并对其记录进行了回顾性分析。共有 51 例患者接受单纯 RT 治疗，20 例患者接受 CRT 治疗。对复发情况进行了分析。使用 Kaplan-Meier 法估计总生存率（OS）和无病生存率（DFS）。采用 Cox 回归分析。
诊断时的中位年龄为 61 岁（范围 18-92 岁），幸存者的中位随访时间为 3.0 年。RT 和 CRT 两组之间的 OS 和 DFS 差异具有统计学意义（3 年 OS = 56%对 79%，log-rank p = 0.037；3 年 DFS = 43%对 73%，log-rank p = 0.011）。在 RT 组中，有 23 例（45%）患者在任何部位复发，而在 CRT 组中仅有 3 例（15%）患者（p = 0.027）。就首次复发的部位而言，10 例（14%）患者为局部复发，4 例（6%）患者为局部和区域复发，9 例（13%）患者为区域复发，1 例（1%）患者为区域和远处转移，2 例（3%）患者为远处转移。单因素分析显示，同期化疗、FIGO 分期、肿瘤大小和诊断日期是 DFS 的显著预测因素。多因素分析显示，同期化疗仍然是 DFS 的显著预测因素（风险比 0.31（95%CI，0.10-0.97；p = 0.04））。
阴道癌的治疗结果较差。为确保治愈性治疗，必须给予足够的放疗剂量。应考虑为阴道癌患者提供同期化疗。
