Yoon Hong In, Cha Jihye, Keum Ki Chang, Lee Ha Yoon, Nam Eun Ji, Kim Sang Wun, Kim Sunghoon, Kim Young Tae, Kim Gwi Eon, Kim Yong Bae
Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.
Department of Pharmacology, Brain Korea 21 plus Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea.
Radiat Oncol. 2015 Jan 13;10:18. doi: 10.1186/s13014-014-0320-5.
To review the clinical outcomes of extended-field radiation therapy (EFRT) and to analyze prognostic factors significant for survival in patients receiving EFRT for uterine cervical carcinoma with para-aortic node (PAN) metastasis.
We retrospectively reviewed 90 patients with stage IB-IVA cervical cancer and PAN metastasis between 1987 and 2012. Median age was 50 (range, 24-77). Patients received median 70.2 Gy (range, 56-93) to point A and median 50.4 Gy (range, 45-60.4) to PAN over median 69 elapsed days (range, 43-182). Forty-six patients (51.1%) received concurrent chemotherapy. Survival was calculated using the Kaplan-Meier method. We analyzed prognostic factors for overall actuarial survival (OS) and progression-free survival (PFS) using a Cox regression method.
The median follow-up period for surviving patients was 55 months (range, 3-252). Seventy patients (77.8%) had complete remission. Forty-six patients experienced treatment failure as follows: 11 patients (12.2%) as local recurrence, 19 (21%) as regional recurrence and 33 (36.7%) as distant metastasis. The 5-yr OS and PFS were 62.6% and 43.9%, respectively. Treatment response was the only statistically independent prognostic factors for OS (p= 0.04) and PFS (p< 0.001) on multivariate analysis. Grade 3 or 4 hematologic gastrointestinal and urogenital toxicities were observed in about 10% of patients.
Our institutional experiences showed that EFRT was an effective treatment for cervical cancer patients with PAN metastasis. The addition of chemotherapy to EFRT seems to have uncertain survival benefit with higher hematologic toxicity.
回顾扩大野放射治疗（EFRT）的临床疗效，并分析接受EFRT治疗的伴有主动脉旁淋巴结（PAN）转移的子宫颈癌患者生存的预后因素。
我们回顾性分析了1987年至2012年间90例IB-IVA期宫颈癌伴PAN转移的患者。中位年龄为50岁（范围24-77岁）。患者至A点的中位照射剂量为70.2 Gy（范围56-93 Gy），至PAN的中位照射剂量为50.4 Gy（范围45-60.4 Gy），中位疗程为69天（范围43-182天）。46例患者（51.1%）接受了同步化疗。采用Kaplan-Meier法计算生存率。我们使用Cox回归方法分析总精算生存率（OS）和无进展生存率（PFS）的预后因素。
存活患者的中位随访期为55个月（范围3-252个月）。70例患者（77.8%）完全缓解。46例患者出现治疗失败，情况如下：11例患者（12.2%）为局部复发，19例（21%）为区域复发，33例（36.7%）为远处转移。5年OS率和PFS率分别为62.6%和43.9%。多因素分析显示，治疗反应是OS（p = 0.04）和PFS（p < 0.001）唯一具有统计学意义的独立预后因素。约10%的患者出现3级或4级血液学、胃肠道和泌尿生殖系统毒性反应。
我们机构的经验表明，EFRT是治疗伴有PAN转移的宫颈癌患者的有效方法。EFRT联合化疗似乎对生存获益不确定，且血液学毒性更高。
