Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, 4-2 Kikusui, Shiroishi-ku, Sapporo, 003-0804, Japan.
Int J Clin Oncol. 2018 Feb;23(1):126-133. doi: 10.1007/s10147-017-1191-1. Epub 2017 Sep 19.
The therapeutic significance of neoadjuvant chemotherapy (NAC) followed by radiation therapy (RT) was negated during the early 1990s. Here, we compared post-NAC RT to surgery for chemo-sensitive cervical squamous cell carcinoma (SCC).
This study included 79 consecutive patients with cervical SCC who were treated by NAC followed by surgery (n = 49) or by definitive RT (n = 30). We compared characteristics and survival outcomes between the surgery and RT groups by their responses to NAC.
Of the 79 patients, 70 (89%) had stage II-IV disease and 41 (52%) had radiological pelvic lymph node enlargement. The 5-year disease-specific survival (DSS) rate of the entire cohort was 66.4% (median follow-up 54 months). Fifty-five patients (70%) achieved sufficient (complete or partial) responses to NAC. Among patients with insufficient NAC responses, the 5-year DSS rate of the surgery group (55.6%) was significantly higher than the RT group (20.0%; P = 0.044). However, among patients with sufficient responses to NAC, 5-year DSS rates did not significantly differ between the surgery and RT groups (82.3 vs 78.6%; P = 0.79) even though the RT group had many more unfavorable prognostic factors and received fewer subsequent treatments than the surgery group.
Post-NAC survival outcomes among patients with chemo-sensitive cervical SCC who then underwent RT were not inferior to those treated with surgery, and NAC did not detract from the efficacy of subsequent RT. Among selected patients who respond favorably to NAC, RT could be a less invasive substitute for surgery without compromising treatment outcomes.
新辅助化疗（NAC）加放疗（RT）的治疗意义在 20 世纪 90 年代初被否定。在此，我们比较了新辅助化疗后加 RT 与手术治疗化疗敏感型宫颈鳞癌（SCC）的效果。
本研究纳入了 79 例接受 NAC 治疗后行手术（n=49）或根治性 RT（n=30）的宫颈 SCC 患者。我们根据 NAC 反应比较了手术组和 RT 组的特征和生存结局。
79 例患者中，70 例（89%）为 II-IV 期，41 例（52%）有影像学盆腔淋巴结肿大。全组 5 年疾病特异性生存率（DSS）为 66.4%（中位随访 54 个月）。70 例（70%）患者对 NAC 有足够（完全或部分）反应。在 NAC 反应不足的患者中，手术组的 5 年 DSS 率（55.6%）明显高于 RT 组（20.0%；P=0.044）。然而，在对 NAC 有足够反应的患者中，手术组和 RT 组的 5 年 DSS 率无显著差异（82.3% vs 78.6%；P=0.79），尽管 RT 组有更多的不利预后因素，且接受的后续治疗少于手术组。
对化疗敏感的宫颈 SCC 患者行 NAC 后行 RT 的生存结局不劣于手术治疗，且 NAC 并未降低后续 RT 的疗效。在对 NAC 反应良好的患者中，RT 可作为手术的一种侵袭性较小的替代方法，而不影响治疗结局。
