对于 IB2 期至 IIIB 期宫颈癌、盆腔淋巴结阳性和腹主动脉旁淋巴结阴性的患者，采用低剂量、预防性、扩展野、强度调制放疗加同期每周顺铂治疗。

Low-dose, prophylactic, extended-field, intensity-modulated radiotherapy plus concurrent weekly cisplatin for patients with stage IB2-IIIB cervical cancer, positive pelvic lymph nodes, and negative para-aortic lymph nodes.

机构信息

*Department of Radiation Therapy and Oncology, China Medical University Hospital, and †College of Medicine, China Medical University, Taichung; ‡College of Medicine, Taipei Medical University, Taipei; and §Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan.

出版信息

Int J Gynecol Cancer. 2014 Jun;24(5):901-7. doi: 10.1097/IGC.0b013e31829f4dc5.

DOI:10.1097/IGC.0b013e31829f4dc5

PMID:23975081

Abstract

OBJECTIVE

The objective of this study was to assess prospectively the clinical outcomes of low-dose prophylactic extended-field, intensity-modulated radiotherapy (IMRT) plus concurrent weekly cisplatin for patients with stage IB2-IIIB cervical cancer, positive pelvic lymph nodes (PLNs), and negative para-aortic lymph nodes (PALNs).

METHODS

Thirty-two patients with stage IB2-IIIB cervical cancer with positive PLN and negative PALN were included prospectively. All lymph nodes were assessed with positron emission tomography. The PALN field, including lymphatics from the superior border of L1 to the L4-L5 interphase, was irradiated concurrently with pelvic IMRT with a prescribed dose of 40 Gy in 25 fractions. Chemotherapy consisted of cisplatin delivered weekly at a dose of 40 mg/m. Using historical controls treated with pelvic radiotherapy, the survival curves were compared to assess the difference between the 2 treatment periods.

RESULTS

Thirty-one patients completed the allocated extended-field IMRT, and all finished the planned pelvic IMRT and brachytherapy. Acute ≥ grade 3 gastrointestinal, genitourinary, and hematologic toxicities were seen in 2, 1, and 18 patients, respectively. During a median follow-up of 33 months, 5 patients developed out-field distant recurrences. One patient had a late grade 3 gastrointestinal complication, and 1 patient had genitourinary toxicity. The 3-year actuarial overall survival, disease-free survival, and distant metastasis-free survival for the study cohort and historic controls were 87% versus 62% (P = 0.02), 82% versus 54% (P = 0.02), and 79% versus 57% (P = 0.01), respectively.

CONCLUSIONS

Extended-field IMRT of 40 Gy to the PALN plus concurrent cisplatin can effectively eradicate subclinical disease at the PALN and improve the outcome for patients with PLN-positive stage IB2-IIIB cervical cancer.

摘要

目的

本研究旨在前瞻性评估低剂量预防性扩展野调强放疗（IMRT）加同期每周顺铂治疗盆腔淋巴结（PLN）阳性、腹主动脉旁淋巴结（PALN）阴性的 IB2-IIIB 期宫颈癌患者的临床结局。

方法

前瞻性纳入 32 例 PLN 阳性、PALN 阴性的 IB2-IIIB 期宫颈癌患者。所有淋巴结均采用正电子发射断层扫描评估。PALN 野包括从 L1 上缘到 L4-L5 椎间的淋巴管，与盆腔 IMRT 同期照射，盆腔 IMRT 处方剂量为 40 Gy，共 25 次。化疗采用每周 40mg/m 的顺铂。使用接受盆腔放疗的历史对照，比较生存曲线以评估两个治疗期之间的差异。

结果

31 例患者完成了分配的扩展野 IMRT，所有患者均完成了计划的盆腔 IMRT 和近距离放疗。2 例患者出现急性≥3 级胃肠道、泌尿生殖系统和血液学毒性，18 例患者分别出现 1 例急性≥3 级胃肠道、泌尿生殖系统和血液学毒性。中位随访 33 个月期间，5 例患者出现野外远处复发。1 例患者出现晚期 3 级胃肠道并发症，1 例患者出现泌尿生殖系统毒性。研究队列和历史对照的 3 年总生存率、无病生存率和远处转移无复发生存率分别为 87%比 62%（P=0.02）、82%比 54%（P=0.02）和 79%比 57%（P=0.01）。