Wang Weiping, Hou Xiaorong, Yan Junfang, Shen Jie, Lian Xin, Sun Shuai, Liu Zhikai, Meng Qingyu, Wang Dunhuang, Zhao Mei, Qiu Jie, Hu Ke, Zhang Fuquan
Department of radiation oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China.
BMC Cancer. 2017 Aug 1;17(1):510. doi: 10.1186/s12885-017-3503-2.
Concurrent chemoradiotherapy (CCRT) is the standard treatment for local advanced cervical cancer. However, for elderly patients, studies are limited and the outcomes are controversial. We retrospectively analyzed the efficacy and tolerance of radical radiotherapy (RT) or CCRT in elderly cervical cancer patients and performed comparisons between them.
We retrospectively analyzed the elderly cervical cancer patients (≥70 years old) treated with radical RT or CCRT between January 2006 and December 2014. For external beam radiotherapy, 50Gy in 25 fractions or 50.4Gy in 28 fractions were delivered via 3-dimensional conformal radiation therapy or intensity modulated radiation therapy. High-dose-rate intracavitary brachytherapy was performed with a dose of 30-36Gy in 5-7 fractions to point A. Concurrent chemotherapy regimens included weekly cisplatin and paclitaxel.
Seventy-three patients were eligible for this study. Twenty-one(28.8%) and 52(71.2%) patients suffered with FIGO stage IB-IIA and IIB-IVA disease, respectively. Twenty-four (32.9%) patients received CCRT. The median duration of follow-up was 32.4 months (4.8-118.8 months). The 3-year overall survival (OS), cancer-specific survival (CSS) and disease-free survival (DFS) were 64.9%, 67.8% and 66.5%, respectively. By multivariate analysis, CCRT was a significant predictive factor of OS(p = 0.023, 95% confidence interval [CI]: 1.172-8.860), CSS(p = 0.031, 95% CI: 1.131-13.908)and DFS(p = 0.045, 95% CI: 1.023 ~ 6.430). The 3-year OS of patients received RT and CCRT were 54.3% and 83.1%, CSS were 56.8% and 87.1%, DFS were 57.6% and 83.3%. There was no treatment related death. Grade 3-4 acute hematological, gastrointestinal and urinary toxicity incidences were 31.5%, 19.1% and 12.3%, respectively. For grade 3-4 chronic gastrointestinal and genitourinary toxicities, the incidences were 4.1% and 2.7%, respectively. Compared with RT, CCRT was related with high grade 3-4 hematological toxicity (16.3% and 62.5% respectively, p < 0.001), respectively. However, acute nonhematological toxicity and chronic toxicity were not significantly different.
Elderly cervical cancer patients could tolerate radical RT and CCRT very well and get a favored survival. Compared with RT, CCRT could improve the survival of elder cervical cancer patients with similar nonhematological toxicity. CCRT should be considered in elderly cervical cancer patients.
同步放化疗（CCRT）是局部晚期宫颈癌的标准治疗方法。然而，对于老年患者，相关研究有限，且结果存在争议。我们回顾性分析了老年宫颈癌患者接受根治性放疗（RT）或CCRT的疗效和耐受性，并对两者进行了比较。
我们回顾性分析了2006年1月至2014年12月期间接受根治性RT或CCRT治疗的老年宫颈癌患者（≥70岁）。对于外照射放疗，通过三维适形放疗或调强放疗给予25次分割共50Gy或28次分割共50.4Gy。高剂量率腔内近距离放疗给予A点剂量30 - 36Gy，分5 - 7次。同步化疗方案包括每周使用顺铂和紫杉醇。
73例患者符合本研究条件。分别有21例（28.8%）和52例（71.2%）患者患有国际妇产科联盟（FIGO）分期IB - IIA期和IIB - IVA期疾病。24例（32.9%）患者接受了CCRT。中位随访时间为32.4个月（4.8 - 118.8个月）。3年总生存率（OS）、癌症特异性生存率（CSS）和无病生存率（DFS）分别为64.9%、67.8%和66.5%。通过多因素分析，CCRT是OS（p = 0.023，95%置信区间[CI]：1.172 - 8.860）、CSS（p = 0.031，95% CI：1.131 - 13.908）和DFS（p = 0.045，95% CI：1.023 ~ 6.430）的显著预测因素。接受RT和CCRT患者的3年OS分别为54.3%和83.1%，CSS分别为56.8%和87.1%，DFS分别为57.6%和83.3%。没有与治疗相关的死亡。3 - 4级急性血液学、胃肠道和泌尿系统毒性发生率分别为31.5%、19.1%和12.3%。对于3 - 4级慢性胃肠道和生殖泌尿系统毒性，发生率分别为4.1%和2.7%。与RT相比，CCRT与更高等级的3 - 4级血液学毒性相关（分别为16.3%和62.5%，p < 0.001）。然而，急性非血液学毒性和慢性毒性没有显著差异。
老年宫颈癌患者能够很好地耐受根治性RT和CCRT，并获得良好的生存率。与RT相比，CCRT可以提高老年宫颈癌患者的生存率，且非血液学毒性相似。老年宫颈癌患者应考虑CCRT。
