宫颈癌标准同步放化疗中添加新辅助化疗的利弊：一个地区癌症中心的经验
Pros and Cons of Adding of Neoadjuvant Chemotherapy to Standard Concurrent Chemoradiotherapy in Cervical Cancer: A Regional Cancer Center Experience.
作者信息
Narayan Satya, Sharma Neeti, Kapoor Akhil, Sharma Rajani, Kumar Narendra, Singhal Mukesh, Purohit Ramesh, Jakhar Shankar Lal, Beniwal Surendra, Kumar Harvindra Singh, Sharma Ajay
机构信息
Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment & Research Institute, Sardar Patel Medical College, Bikaner, 334003 Rajasthan India ; PG Boys Hostel, PBM Hospital Campus, Bikaner, 334003 Rajasthan India.
Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment & Research Institute, Bikaner, Rajasthan India.
出版信息
J Obstet Gynaecol India. 2016 Oct;66(5):385-90. doi: 10.1007/s13224-015-0698-5. Epub 2015 Jul 11.
BACKGROUND
The present study summarizes the results of treatment in the form of disease-free survival and overall survival in bulky stage IB2 and locally advanced (stages II-IVA) squamous cell carcinoma of the uterine cervix. The treatment has been given in the form of NACT followed by CCRT in one arm and CCRT in the other arm.
MATERIALS AND METHODS
This retrospective study analyzed 713 cervical cancer patients who were treated at our center during 2007 and 2008; out of 713 patients, data of 612 patients have been compared. The patients' data were analyzed retrospectively. Patients had undergone PF 28.6 %, TPF 21.5 %, and only CCRT 49.9 %. Majority of patients were in the age group 41-50 years, while stage wise, mainly stage IIIb and IIb. Disease-free survival was observed on the basis of stage and NACT. The survival analyses were performed using the Kaplan-Meier method. All statistical calculations were done with SPSS Statistics version 20.0.
RESULTS
For cancer cervix NACT versus CCRT, the DFS rate was at 5 years (58.3 vs. 41.8 % p = 0.001). NACT followed by CCRT demonstrated significantly superior DFS as compared to definitive CCRT, respectively, TPF (hazard ratio (HR) = 0.248, 95 % confidence interval (CI) 0.123-0.500; p < 0.001), PF (HR = 0.445, 95 % CI 0.266-0.722; p = 0.002). The results of univariate stage, age, and multivariate study show that stage hemoglobin level, interval between external-intracavitary radiation, and type of neoadjuvant chemotherapy were the factors affected survival cervical patients treated with radiation. The grade 3/4 hematologic toxicities were more in the NACT group than CCRT (p < 0.001) while the non-hematological toxicity was not significant; the TPF group experienced more toxicity than PF (p = 0.029). This treatment regimen is feasible as evidenced by the acceptable toxicity of NACT and by the high compliance to radiotherapy. The grade 3/4 hematologic toxicities were more in NACT groups than CCRT (p < 0.001); the TPF group experienced more toxicity than PF (p = 0.029).
CONCLUSION
TPF/PF as NACT is feasible and produces impressive responses in cancer cervix.
背景
本研究总结了 IB2 期巨块型和局部晚期（II-IVA 期）子宫颈鳞状细胞癌患者以无病生存期和总生存期形式呈现的治疗结果。治疗方式为一组先进行新辅助化疗（NACT）后行同步放化疗（CCRT），另一组直接行 CCRT。
材料与方法
这项回顾性研究分析了 2007 年至 2008 年在本中心接受治疗的 713 例宫颈癌患者；在这 713 例患者中，对 612 例患者的数据进行了比较。对患者数据进行回顾性分析。患者接受 PF 方案的占 28.6%，TPF 方案的占 21.5%，仅接受 CCRT 的占 49.9%。大多数患者年龄在 41 - 50 岁之间，按分期来看，主要是 IIIb 期和 IIb 期。基于分期和 NACT 观察无病生存期。使用 Kaplan-Meier 方法进行生存分析。所有统计计算均使用 SPSS Statistics 20.0 版本完成。
结果
对于宫颈癌，NACT 组与 CCRT 组相比，5 年无病生存率分别为 58.3%和 41.8%（p = 0.001）。与单纯 CCRT 相比，NACT 后行 CCRT 显示出显著更高的无病生存率，TPF 方案（风险比（HR）= 0.248，95%置信区间（CI）0.123 - 0.500；p < 0.001），PF 方案（HR = 0.445，95%CI 0.266 - 0.722；p = 0.002）。单因素分期、年龄及多因素研究结果表明，分期、血红蛋白水平、腔内与体外放疗间隔时间以及新辅助化疗类型是影响接受放疗的宫颈癌患者生存的因素。3/4 级血液学毒性在 NACT 组比 CCRT 组更常见（p < 0.001），而非血液学毒性不显著；TPF 组比 PF 组毒性更大（p = 0.029）。NACT 可接受的毒性及放疗的高依从性证明该治疗方案是可行的。3/4 级血液学毒性在 NACT 组比 CCRT 组更常见（p < 0.001）；TPF 组比 PF 组毒性更大（p = 0.029）。
结论
TPF/PF 作为 NACT 方案治疗宫颈癌是可行的，且产生了令人印象深刻的疗效。
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