Orton Andrew, Boothe Dustin, Williams Ned, Buchmiller Thomas, Huang Y Jessica, Suneja Gita, Poppe Matthew, Gaffney David
University of Utah, Huntsman Cancer Institute, Department of Radiation Oncology, Salt Lake City, UT, United States.
University of Utah, Salt Lake City, UT, United States.
Gynecol Oncol. 2016 Jun;141(3):501-506. doi: 10.1016/j.ygyno.2016.03.011. Epub 2016 Apr 1.
Prospective, randomized data does not exist to guide treatment in primary vaginal cancer (PVC). We evaluated the impact of brachytherapy on survival in women with PVC.
Women who received radiotherapy for PVC were identified using the Surveillance, Epidemiology, and End Result database. Two retrospective cohorts were created; women who received external beam radiotherapy (EBRT) alone and those who received brachytherapy (alone or in combination of EBRT). Nearest-neighbor propensity score matching was used to balance the groups according to measured covariates. Cox proportional hazard regression modeling was used to estimate the effect of receipt of brachytherapy on survival.
Two thousand five hundred seventeen vaginal cancer patients were identified. Squamous cell carcinoma made up 75% of tumors. Median overall survival (OS) for patients receiving EBRT alone was 3.6years (95% CI, 3.0-4.2years) versus 6.1years (95% CI 5.2-7.2years) for patients receiving brachytherapy (p=<0.001). Cox proportional hazard model revealed decrease risk of death among patients that received brachytherapy in the matched cohort (HR 0.77; 95% CI 0.68-0.86). Brachytherapy reduced risk of death among patients in all stage groups. No patient demographic or tumor variables favored the use of EBRT alone. Brachytherapy was associated with a decreased risk of death for all FIGO stages. Brachytherapy benefited patients with squamous cell carcinoma (HR 0.80; 95% CI 0.70-0.92) and adenocarcinoma (HR 0.69; 95% CI 0.49-0.95). Tumors larger than 5cm had the greatest benefit from brachytherapy (HR 0.68; 95% CI 0.50-0.91).
Brachytherapy should be encouraged for all suitable patients with PVC.
目前尚无前瞻性随机数据可用于指导原发性阴道癌（PVC）的治疗。我们评估了近距离放射治疗对PVC女性患者生存的影响。
利用监测、流行病学和最终结果数据库确定接受PVC放射治疗的女性。创建了两个回顾性队列；仅接受外照射放疗（EBRT）的女性和接受近距离放射治疗（单独或与EBRT联合）的女性。使用最近邻倾向评分匹配根据测量的协变量平衡各组。采用Cox比例风险回归模型估计接受近距离放射治疗对生存的影响。
共确定了2517例阴道癌患者。鳞状细胞癌占肿瘤的75%。仅接受EBRT的患者中位总生存期（OS）为3.6年（95%CI，3.0 - 4.2年），而接受近距离放射治疗的患者为6.1年（95%CI 5.2 - 7.2年）（p =<0.001）。Cox比例风险模型显示，在匹配队列中接受近距离放射治疗的患者死亡风险降低（HR 0.77；95%CI 0.68 - 0.86）。近距离放射治疗降低了所有分期组患者的死亡风险。没有患者人口统计学或肿瘤变量支持单独使用EBRT。近距离放射治疗与所有国际妇产科联盟（FIGO）分期患者的死亡风险降低相关。近距离放射治疗使鳞状细胞癌（HR 0.80；95%CI 0.70 - 0.92）和腺癌（HR 0.69；95%CI 0.49 - 0.95）患者受益。大于5cm的肿瘤从近距离放射治疗中获益最大（HR 0.68；95%CI 0.50 - 0.91）。
对于所有合适的PVC患者，应鼓励采用近距离放射治疗。
