Bandera L, La Face B, Antonioli C, Galelli M, Ghedi B, Fiume A, Buglione M, Magrini S M, Sartori E
Eur J Gynaecol Oncol. 2014;35(2):121-7.
To add to the existing outcome data regarding radical radiotherapy (RT) for FIGO Stage I and II cervical cancer in a mono-institutional series and to evaluate the cost-benefit ratio of the addition of brachytherapy (BRA) to external-beam radiotherapy (EBRT).
The authors report on 240 patients (pts) with FIGO Stage I and II cervical cancer, consecutively treated with radical RT from 1990 through 2009 at the Istituto del Radio "O. Alberti" (EBRT alone, 32, EBRT and BRA, 189, BRA alone, 19). BRA was delivered with low dose rate (LDR, 133.64%) until 2003 and then with high dose rate (HDR, 75.36%). RT was associated with concomitant chemotherapy (CHT), mainly weekly cisplatin 40 mg/m2, in 87 pts, mostly after 2000. The Chi-square test was used to compare the different variables, the Log-Rank test to compare the actuarial survival values, and the Cox-model for the multivariate analysis.
Five-year actuarial overall survival (OS) equalled 65%, disease specific survival (DSS) 77%. Regardless of disease stage, better DSS was evident in pts treated with EBRT and BRA compared with those treated with EBRT alone (82% and 58% respectively, p = 0.005); pts treated with concomitant CHT (dose intensity > or = 50%) and higher RT doses (RT cumulative EQD2 > or = 75 Gy) obtained better DSS. Complete response (CR) rate approached 88.4% (206/233 evaluable pts) and more than half of the subsequent failures (21/36) were in distant sites. Older patients and those given BRA had better OS and DSS, while BRA dose rate did not result related with these outcomes. Chronic G3/G4 toxicity involved more frequently the intestinal/rectal tract than other organs at risk. Rectal and vaginal serious chronic sequelae developed mainly in pts treated with EBRT and BRA and suggest the need for more advanced treatment techniques.
the present mono-institutional analysis confirms the efficacy of radical RT for the treatment of cervical cancer and provides support to the role of BRA to obtain better outcomes. An effort to reduce long-term toxicity of the treatment is needed.
在单机构系列研究中补充关于国际妇产科联盟（FIGO）I期和II期宫颈癌根治性放疗（RT）的现有结果数据，并评估在体外放射治疗（EBRT）基础上加用近距离放疗（BRA）的成本效益比。
作者报告了240例FIGO I期和II期宫颈癌患者，这些患者于1990年至2009年在“O. Alberti”放射研究所接受根治性放疗（单纯EBRT 32例，EBRT联合BRA 189例，单纯BRA 19例）。2003年以前，BRA采用低剂量率（LDR，133.64%），之后采用高剂量率（HDR，75.36%）。87例患者放疗联合同步化疗（CHT），主要为每周顺铂40mg/m²，大多在2000年以后。采用卡方检验比较不同变量，采用对数秩检验比较精算生存值，采用Cox模型进行多因素分析。
5年精算总生存率（OS）为65%，疾病特异性生存率（DSS）为77%。无论疾病分期如何，与单纯接受EBRT治疗的患者相比，接受EBRT联合BRA治疗的患者DSS更高（分别为82%和58%，p = 0.005）；接受同步CHT（剂量强度≥50%）和更高放疗剂量（放疗累积等效剂量（EQD2）≥75 Gy）的患者DSS更好。完全缓解（CR）率接近88.4%（233例可评估患者中的206例），半数以上后续复发（36例中的21例）发生在远处部位。老年患者和接受BRA治疗的患者OS和DSS更好，而BRA剂量率与这些结果无关。慢性3/4级毒性反应累及肠道/直肠的频率高于其他危险器官。直肠和阴道严重慢性后遗症主要发生在接受EBRT联合BRA治疗的患者中，提示需要更先进的治疗技术。
本单机构分析证实了根治性放疗治疗宫颈癌的有效性，并支持BRA在获得更好治疗效果方面的作用。需要努力降低治疗的长期毒性。
