Mabuchi Seiji, Isohashi Fumiaki, Okazawa Mika, Kitada Fuminori, Maruoka Shintaro, Ogawa Kazuhiko, Kimura Tadashi
Department of Obstetrics and Gynecology, Osaka University, Graduate School of Medicine, Osaka, Japan.
Department of Radiation Oncology, Osaka University, Graduate School of Medicine, Osaka, Japan.
J Gynecol Oncol. 2017 Jan;28(1):e15. doi: 10.3802/jgo.2017.28.e15.
To evaluate the efficacy and toxicity of paclitaxel plus carboplatin (TC)-based concurrent chemoradiotherapy (CCRT) followed by consolidation chemotherapy in the International Federation of Gynecology and Obstetrics (FIGO) stage IIIB/IVA cervical cancer patients.
We reviewed the medical records of FIGO stage IIIB/IVA cervical cancer patients (n=30) who had been intended to be treated with TC-based CCRT followed by consolidation chemotherapy (TC-CCRT-group) from April 2012-May 2016. Patients who had been treated with CCRT involving a single platinum agent (CCRT-group; n=52) or definitive radiotherapy alone (RT-group; n=74) from January 1997-September 2012 were also identified and used as historical controls. Survival was calculated using the Kaplan-Meier method and compared using the log-rank test.
Of the 30 patients included in the TC-CCRT-group, 22 patients (73.3%) completed the planned TC-based CCRT. The most frequently observed acute grade 3/4 hematological toxicities were leukopenia and neutropenia, and diarrhea was the most common acute grade 3/4 non-hematological toxicity. After a median follow-up of 35 months, 9 patients (30.0%) had developed recurrent disease. The patients' estimated 3-year progression-free survival (PFS) and overall survival (OS) rates were 67.9% and 90.8%, respectively. In comparisons with historical control groups, the survival outcomes of TC-CCRT-group was significantly superior to CCRT-group in terms of OS (p=0.011) and significantly superior to RT-group in terms of both PFS (p=0.009) and OS (p<0.001).
TC-based CCRT followed by consolidation chemotherapy is safe and effective. A randomized controlled study needs to be conducted to further evaluate the efficacy of this multimodal approach in this patient population.
评估以紫杉醇联合卡铂（TC）为基础的同步放化疗（CCRT）联合巩固化疗在国际妇产科联盟（FIGO）IIIB/IVA期宫颈癌患者中的疗效和毒性。
我们回顾了2012年4月至2016年5月期间拟接受以TC为基础的CCRT联合巩固化疗（TC-CCRT组，n = 30）的FIGO IIIB/IVA期宫颈癌患者的病历。还确定了1997年1月至2012年9月期间接受过含单一铂类药物的CCRT治疗（CCRT组，n = 52）或单纯根治性放疗（RT组，n = 74）的患者，并将其作为历史对照。采用Kaplan-Meier法计算生存率，并使用对数秩检验进行比较。
在TC-CCRT组纳入的30例患者中，22例（73.3%）完成了计划的以TC为基础的CCRT。最常观察到的3/4级急性血液学毒性是白细胞减少和中性粒细胞减少，腹泻是最常见的3/4级急性非血液学毒性。中位随访35个月后，9例（30.0%）患者出现疾病复发。患者的3年无进展生存率（PFS）和总生存率（OS）估计分别为67.9%和90.8%。与历史对照组相比，TC-CCRT组的生存结果在OS方面显著优于CCRT组（p = 0.011），在PFS（p = 0.009）和OS（p < 0.001）方面均显著优于RT组。
以TC为基础的CCRT联合巩固化疗安全有效。需要进行一项随机对照研究，以进一步评估这种多模式方法在该患者群体中的疗效。
