Laan J J, van Lonkhuijzen L R C W, van Os R M, Tytgat K M, Dávila Fajardo R, Pieters B R, Stalpers L J A, Westerveld G H
Department of Radiotherapy/Radiation Oncology, Academic Medical Center - Cancer Center Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Department of Gynecology, Academic Medical Center - Cancer Center Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Gynecol Oncol. 2017 Dec;147(3):684-689. doi: 10.1016/j.ygyno.2017.10.013. Epub 2017 Oct 23.
To evaluate the frequency of and risk factors for severe late bowel toxicity after curative radiotherapy in women treated for locally advanced cervical cancer.
Included were 515 women treated for locally advanced cervical cancer with primary radiotherapy with curative intent from 1992 to 2013. Bowel toxicity was graded according to the Common Terminology Criteria for Adverse Events. Associations between risk factors and severe late bowel toxicity were assessed using Cox proportional hazards regression models.
Median follow-up was 78months. Fifty-nine patients developed severe late bowel toxicity. The actuarial 3-year and 5-year severe late bowel toxicity rates were both 13%. In the multivariable analysis, factors significantly associated with severe late bowel toxicity were: smoking (HR 2.59 [1.48-4.55]), severe acute bowel toxicity (HR 2.46 [1.24-4.49]), previous major abdominal surgery (HR 2.35 [1.20-4.60]), hypertension (HR 2.33 [1.23-4.40]), parametrial boost (HR 2.18 [1.10-4.33]), low socioeconomic status (HR 2.05 [1.17-3.59]) and low BMI (HR 0.93 [0.88-0.99]). First symptoms of severe late bowel toxicity were reported after a median follow-up of 9months, but occurred up to 10years after end of treatment. Only one third of the patients with severe late bowel toxicity were referred to a gastroenterologist.
Severe late bowel toxicity is a frequent complication of definitive radiotherapy for cervical cancer. Several independent risk factors were found which warrant further research. A standardized and structured approach in the early diagnostics and management of bowel toxicity is needed.
评估局部晚期宫颈癌女性患者根治性放疗后严重晚期肠道毒性的发生率及危险因素。
纳入1992年至2013年期间接受根治性原发性放疗的515例局部晚期宫颈癌女性患者。根据不良事件通用术语标准对肠道毒性进行分级。使用Cox比例风险回归模型评估危险因素与严重晚期肠道毒性之间的关联。
中位随访时间为78个月。59例患者发生严重晚期肠道毒性。3年和5年的严重晚期肠道毒性精算发生率均为13%。在多变量分析中，与严重晚期肠道毒性显著相关的因素有：吸烟（风险比[HR]2.59[1.48 - 4.55]）、严重急性肠道毒性（HR 2.46[1.24 - 4.49]）、既往腹部大手术（HR 2.35[1.20 - 4.60]）、高血压（HR 2.33[1.23 - 4.40]）、宫旁加量放疗（HR 2.18[1.10 - 4.33]）、社会经济地位低（HR 2.05[1.17 - 3.59]）和低体重指数（HR 0.93[0.88 - 0.99]）。严重晚期肠道毒性的首发症状在中位随访9个月后出现，但在治疗结束后长达10年仍有发生。只有三分之一的严重晚期肠道毒性患者被转诊至胃肠病专家处。
严重晚期肠道毒性是宫颈癌根治性放疗常见的并发症。发现了几个独立的危险因素，值得进一步研究。需要一种标准化和结构化的方法来早期诊断和管理肠道毒性。
