Departments of *Radiation Oncology, and †Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
Int J Gynecol Cancer. 2013 Oct;23(8):1520-7. doi: 10.1097/IGC.0b013e3182a0c0e5.
In this prospective study, symptoms were assessed in patients with locally advanced cervical cancer undergoing concurrent chemoradiotherapy (CTRT) with either weekly cisplatin (WP) or every-3-week cisplatin/5-fluorouracil (PF).
Patients with 1994 International Federation of Gynecology and Obstetrics stage IIB to IVA disease, biopsy-proven involved pelvic nodes, or gross tumor size greater than 5 cm were eligible. Patients requiring paraaortic radiotherapy were excluded. With the use of a modified Edmonton Symptom Assessment Scale, patients reported symptom severity on an 11-point scale 3 times per week during CTRT and at the first follow-up. The Wilcoxon rank sum test and multilevel mixed-effects linear regression were used to assess the effect of chemotherapy regimen on symptoms.
Among the 52 patients included in the final analysis, 37 received WP, 13 received PF, and 2 received 1 cycle of PF followed by WP. Overall compliance with completion of Edmonton Symptom Assessment Scale questionnaires was 75%. There were significant differences in symptom scores for well-being, anorexia, fatigue, diarrhea, and stomatitis favoring the WP regimen. All symptoms except diarrhea were stable and of low intensity in the WP group. In the PF group, symptoms had a cyclical pattern with an initial rise followed by a gradual fall during the 3-week period after chemotherapy. For the 29 patients (56%) who completed the follow-up surveys, scores for all symptoms improved to baseline levels 4 to 6 weeks after treatment.
This analysis provides important patient-reported data regarding the rates and timing of acute symptoms during CTRT that can help clinicians better manage symptoms that impact patients' quality of life.
在这项前瞻性研究中，对接受同期放化疗（CTRT）的局部晚期宫颈癌患者进行了评估，这些患者接受的化疗方案分别为每周顺铂（WP）或每 3 周顺铂/5-氟尿嘧啶（PF）。
本研究纳入了 1994 年国际妇产科联合会（FIGO）分期为 IIB 期至 IVA 期、盆腔淋巴结受累活检证实或肿瘤直径大于 5cm 的患者。需要行腹主动脉旁放疗的患者被排除在外。采用改良的埃德蒙顿症状评估量表（Edmonton Symptom Assessment Scale），患者在 CTRT 期间和首次随访时每周报告 3 次症状严重程度，评分采用 11 分制。采用 Wilcoxon 秩和检验和多级混合效应线性回归评估化疗方案对症状的影响。
在最终分析的 52 例患者中，37 例接受 WP 方案，13 例接受 PF 方案，2 例先接受 1 个周期的 PF 方案，然后改为 WP 方案。完成埃德蒙顿症状评估量表问卷的总体依从性为 75%。WP 组在幸福感、厌食、疲劳、腹泻和口腔炎方面的症状评分明显优于 PF 组。除腹泻外，WP 组所有症状均稳定且强度较低。PF 组在化疗后 3 周内，症状呈周期性变化，最初升高，然后逐渐下降。对于完成随访调查的 29 例患者（56%），所有症状评分在治疗后 4 至 6 周恢复到基线水平。
本分析提供了 CRT 期间急性症状的发生率和时间的重要患者报告数据，有助于临床医生更好地管理影响患者生活质量的症状。
