Jakubowicz J, Blecharz P, Skotnicki P, Reinfuss M, Walasek T, Luczynska E
Eur J Gynaecol Oncol. 2014;35(4):393-9.
The analysis of acute and late toxicity of concurrent chemoradiotherapy (CCRT) for locally advanced cervical cancer (LACC) based on review of 120 patients treated in Centre of Oncology in Krakow between 2001 and 2007.
Medium age of the patients was 52 years (43-66). Overall, 12 patients (10.0%) were in Stage IB2, 54 (45.0%) in Stage II, 43 (35.8%) in Stage III, and 11 (9.2%) in Stage IVA. Squamous cell carcinoma was present in 114 (95.0%) patients. Well-differentiated (grade 1) tumour was found in 39 (32.5%) patients, moderately differentiated (grade 2) in 41 (34.2%), and poorly differentiated (grade 3) in 40 (33.3%). Karnofsky performance status score was 70 in 72 (60.0%) patients, and 80-90 in 48 (40%). External radiation therapy was delivered with high-energy six to 15 MV photon beams using four-field brick technique. The total dose of 50 Gy was given in 25 fractions within five weeks using standard fractionation. Concurrently with external radiotherapy, six cycles of chemotherapy were administered to all the patients as an intravenous infusion of once-weekly cisplatin 40 mg/m2. On completion of external beam radiotherapy, low-dose rate brachytherapy with tandem and two colpostats was performed to deliver the dose of 40 Gy to point A in two 20 Gy insertions at weekly intervals.
Of the 120 patients in the investigated group, 78 (65%) were disease-free for five years. Symptoms of acute treatment-related toxicity grade 3 or 4 (WHO) occurred in 21.6% of patients including leucopoenia in 7.5%. anaemia in 5.0%, nausea and vomiting in 3.3%, diarrhea in 5.0%, and urinary tract infection in 0.8%. Full planned treatment (teleradiotherapy + chemotherapy + brachytherapy) completed 78.3% of the group; full planned radiotherapy without full chemotherapy completed 20% of the patients. Late treatment complications of grade 3 or 4 were observed in two (1.6%) patients (narrowing of large intestine requiring surgery and recto-vaginal fistula).
In patients with LACC treated with CCRT, the most frequent acute toxic effects include: haematological disorders (leucopoenia, anaemia), gastrointestinal disorders (nausea and vomiting, diarrhea), vulvo-vaginal disorders, and urinary tract infection. The most frequent late toxic effects included: rectal bleeding, bowel complications requiring surgery, stenosis or recto-vaginal fistula, and haematuria.
基于对2001年至2007年间在克拉科夫肿瘤中心接受治疗的120例局部晚期宫颈癌(LACC)患者的回顾,分析同步放化疗(CCRT)的急性和晚期毒性。
患者的中位年龄为52岁(43 - 66岁)。总体而言,12例(10.0%)患者处于IB2期,54例(45.0%)处于II期,43例(35.8%)处于III期,11例(9.2%)处于IVA期。114例(95.0%)患者为鳞状细胞癌。39例(32.5%)患者为高分化(1级)肿瘤,41例(34.2%)为中分化(2级),40例(33.3%)为低分化(3级)。72例(60.0%)患者的卡氏功能状态评分为70,48例(40%)患者为80 - 90。采用四野盒式技术,使用6至15MV高能光子束进行外照射放疗。采用标准分割,在5周内分25次给予总剂量50Gy。在进行外照射放疗的同时,所有患者接受6个周期的化疗,通过静脉输注每周一次的顺铂40mg/m²。外照射放疗结束后,使用阴道施源器和两个阴道后装施源器进行低剂量率近距离放疗,分两次每周间隔给予20Gy,使A点剂量达到40Gy。
在研究组的120例患者中,78例(65%)五年无病生存。21.6%的患者出现3级或4级(WHO)急性治疗相关毒性症状,其中白细胞减少症占7.5%,贫血占5.0%,恶心和呕吐占3.3%,腹泻占5.0%,尿路感染占0.8%。该组78.3%的患者完成了全部计划治疗(远距离放疗 + 化疗 + 近距离放疗);20%的患者完成了无完整化疗的全部计划放疗。观察到2例(1.6%)患者出现3级或4级晚期治疗并发症(大肠狭窄需要手术和直肠阴道瘘)。
在接受CCRT治疗的LACC患者中,最常见的急性毒性作用包括:血液系统疾病(白细胞减少症、贫血)、胃肠道疾病(恶心和呕吐、腹泻)、外阴阴道疾病和尿路感染。最常见的晚期毒性作用包括:直肠出血、需要手术的肠道并发症、狭窄或直肠阴道瘘以及血尿。