Hass Peter, Eggemann Holm, Costa Serban Dan, Ignatov Atanas
Department of Radiation Oncology, Universitätsklinikum Magdeburg, Magdeburg, Germany.
Department of Obstetrics and Gynecology, Otto-von-Guericke University, G.-Hauptmann Str. 35, 39108, Magdeburg, Germany.
Strahlenther Onkol. 2017 Dec;193(12):1048-1055. doi: 10.1007/s00066-017-1174-1. Epub 2017 Jun 28.
External beam radiation therapy (EBRT) with concomitant chemotherapy (cCT) (=RCT) plus intracavitary (±interstitial) brachytherapy (iBT) is standard of care for advanced cervical cancer. The aim of this study was to evaluate morbidity and survival outcome of simple adjuvant hysterectomy (AH) after EBRT/cCT and to compare it with the standard treatment.
Patients with FIGO stage III cervical cancer were treated with EBRT/cCT and then divided in two groups: group 1 was further treated with standard intracavitary/interstitial BT, while group 2 underwent AH.
From 881 women with cervical cancer, 248 were eligible for analysis: 161 received iBT and 87 underwent AH. The median follow-up of the study was 53 months. Clinical and pathological characteristics were well balanced in the two groups. After EBRT/cCT, complete clinical response was observed in 121 (48.8%) of 246 patients. Clinical complete response was observed in 81 (50.3%) of 161 patients in group 1. At 6 weeks after EBRT/cCT, 40 (46.0%) of 87 patients in the surgery group had pathological complete response. Intra- and postoperative complications were observed in 10 (11.5%) of 87 cases. The rates of locoregional recurrence and metastasis were similar in both groups. Progression-free (PFS) and disease-specific overall survival (DOS) for these patients were similar between the control and surgery group. Interestingly, PFS and DOS were significantly improved by AH for the patients with residual tumor.
AH could improve survival in patients with residual disease after RCT and is characterized by a low complication rate.
外照射放疗（EBRT）联合同步化疗（cCT）（=RCT）加腔内（±组织间）近距离放疗（iBT）是晚期宫颈癌的标准治疗方案。本研究的目的是评估EBRT/cCT后单纯辅助子宫切除术（AH）的发病率和生存结果，并将其与标准治疗进行比较。
FIGO III期宫颈癌患者接受EBRT/cCT治疗，然后分为两组：第1组进一步接受标准腔内/组织间BT治疗，而第2组接受AH治疗。
在881例宫颈癌女性患者中，248例符合分析条件：161例接受iBT治疗，87例接受AH治疗。该研究的中位随访时间为53个月。两组的临床和病理特征均衡良好。EBRT/cCT后，246例患者中有121例（48.8%）观察到完全临床缓解。第1组161例患者中有81例（50.3%）观察到临床完全缓解。EBRT/cCT后6周，手术组87例患者中有40例（46.0%）达到病理完全缓解。87例患者中有10例（11.5%）观察到术中及术后并发症。两组的局部区域复发和转移率相似。这些患者的无进展生存期（PFS）和疾病特异性总生存期（DOS）在对照组和手术组之间相似。有趣的是，对于有残留肿瘤的患者，AH显著改善了PFS和DOS。
AH可提高RCT后残留疾病患者的生存率，且并发症发生率低。
