Wakatsuki Masaru, Kato Shingo, Ohno Tatsuya, Kiyohara Hiroki, Karasawa Kumiko, Tamaki Tomoaki, Ando Ken, Irie Daisuke, Shiba Shintaro, Tsujii Hirohiko, Nakano Takashi, Kamada Tadashi, Shozu Makio
J Radiat Res. 2015 May;56(3):523-8. doi: 10.1093/jrr/rru117.
We investigated the first site of distant failure after carbon ion radiotherapy (C-ion RT) for locally advanced cervical cancer in three clinical trials. A total of 91 cases were enrolled in the three trials (Protocol 9702, 9704 and 9902). Histologically, 36 cases had squamous cell carcinoma (SqCC) and 55 cases had adenocarcinoma (AC), including 13 with adenosquamous cell carcinoma. The number of cases with Stage IIB, IIIB and IVA disease was 21, 59 and 11, respectively. Of the 91 cases, 42 had positive pelvic lymph nodes (PLNs). The median tumor size was 6.0 cm (range, 3.0–12.0 cm). The median follow-up duration for all cases was 40 months (range, 7–181 months). A total of 40 cases developed distant failure as the first site of failure: 13 of 36 (36.1%) SqCC cases had distant failure, with 9 of them with para-aortic lymph node (PALN) failure; 27 of 55 (44.0%) AC cases had distant failure, and 23 of them had distant failure excluding PALN metastasis. Distant failure rates of SqCC cases who had positive and negative PLNs before C-ion RT were 61.1% and 11.1%, respectively (P = 0.0045). Those of AC cases were 54.2% and 45.2%, respectively (P = 0.507). In conclusion, there were high rates of distant failure after C-ion RT in AC cases regardless of PLN status, and there were high rates of distant failure after C-ion RT, especially PALN failure, in SqCC cases with positive PLNs.
我们在三项临床试验中研究了局部晚期宫颈癌碳离子放疗（C离子放疗）后远处失败的首个部位。三项试验（方案9702、9704和9902）共纳入91例患者。组织学上，36例为鳞状细胞癌（SqCC），55例为腺癌（AC），其中13例为腺鳞癌。IIB期、IIIB期和IVA期疾病的病例数分别为21例、59例和11例。91例患者中，42例盆腔淋巴结（PLN）阳性。肿瘤中位大小为6.0 cm（范围3.0 - 12.0 cm）。所有病例的中位随访时间为40个月（范围7 - 181个月）。共有40例发生远处失败作为首个失败部位：36例SqCC病例中有13例（36.1%）发生远处失败，其中9例为腹主动脉旁淋巴结（PALN）失败；55例AC病例中有27例（44.0%）发生远处失败，其中23例为不包括PALN转移的远处失败。C离子放疗前PLN阳性和阴性的SqCC病例的远处失败率分别为61.1%和11.1%（P = 0.0045）。AC病例的远处失败率分别为54.2%和45.2%（P = 0.507）。总之，无论PLN状态如何，AC病例C离子放疗后远处失败率均较高，而PLN阳性的SqCC病例C离子放疗后远处失败率较高，尤其是PALN失败。
