Lan Mei-Ling, Yu Xian, Xiao He, Zhou Peng, Hu Nan, Liu Yun, Wang Ge
Cancer Center, Institute of Surgical Research, Daping Hospital, The Military Medical University, Chongqing, China.
Medicine (Baltimore). 2017 Nov;96(46):e8384. doi: 10.1097/MD.0000000000008384.
This study aimed to determine whether the addition of intracavitary brachytherapy (ICBT) to chemoradiotherapy (CRT) improves outcome in patients with cervical cancer and poor prognostic factors. Patients with stage IB to IIA cervical cancer who had undergone radical hysterectomy and pelvic lymphadenectomy between August 2008 and December 2014 were retrospectively registered in this study. All patients received external beam radiation therapy (EBRT) + chemotherapy, and some patients additionally received ICBT. EBRT consisted of 45 to 50.4 Gy delivered to the standard pelvic field in 25 to 28 fractions. Chemotherapy consisted of 2 to 4 courses of weekly cisplatin-based treatment. ICBT was delivered in 1 to 3 insertions. Ninety-seven of 163 patients received CRT, and 66 patients additionally received ICBT. During a median follow-up period of 33 months, recurrence was detected in 38 patients. The 3-year locoregional control (LRC), disease-free survival (DFS), and overall survival (OS) rates did not differ significantly between patients who did and did not receive ICBT. In subgroup analyses, fewer recurrences were seen in patients with at least 1 high-risk factor who received ICBT than in those who did not, with a significant (62%) reduction in the risk of progression or death (hazard ratio 0.384, 95% confidence interval 0.151-0.978, P = .045). The difference in OS between the CRT and CRT + ICBT subgroups was marginal (P = .064). The addition of ICBT to CRT after radical surgery significantly improves LRC and DFS rates in women with cervical cancer and at least 1 high-risk factor.
本研究旨在确定腔内近距离放射治疗（ICBT）联合放化疗（CRT）是否能改善具有预后不良因素的宫颈癌患者的治疗结局。对2008年8月至2014年12月期间接受根治性子宫切除术和盆腔淋巴结清扫术的IB至IIA期宫颈癌患者进行回顾性登记。所有患者均接受外照射放疗（EBRT）+化疗，部分患者还接受了ICBT。EBRT包括在25至28次分割中向标准盆腔野给予45至50.4Gy的剂量。化疗包括2至4个疗程的每周顺铂为基础的治疗。ICBT分1至3次插入进行。163例患者中有97例接受了CRT，66例患者还接受了ICBT。在中位随访期33个月期间，38例患者出现复发。接受和未接受ICBT的患者之间，3年局部区域控制（LRC）、无病生存（DFS）和总生存（OS）率无显著差异。在亚组分析中，至少有1个高危因素且接受ICBT的患者复发少于未接受ICBT的患者，进展或死亡风险显著降低（62%）（风险比0.384，95%置信区间0.151 - 0.978，P = 0.045）。CRT和CRT + ICBT亚组之间的OS差异不显著（P = 0.064）。根治性手术后CRT联合ICBT可显著提高具有至少1个高危因素的宫颈癌女性的LRC和DFS率。
