Dracham Chinna Babu, Mahajan Rohit, Rai Bhavana, Elangovan Arun, Bhattacharya Tapesh, Ghoshal Sushmita
Department of Radiotherapy & Oncology, PGIMER, Chandigarh.
Jpn J Clin Oncol. 2019 Feb 1;49(2):146-152. doi: 10.1093/jjco/hyy164.
OBJECTIVE(S): This study aimed to retrospectively evaluate the toxicity and clinical outcomes in patients of locally advanced cervical cancer treated with three-dimensional conformal radiotherapy (3DCRT) and concurrent chemotherapy.
Two hundred and ten newly diagnosed patients of locally advanced cervical cancer of FIGO 2009 Stage II-III treated with 3DCRT (46 Gy/23 fractions/4½ weeks) and weekly concurrent Cisplatin (40 mg/m2), from January 2013 to 2015 were analyzed. A planning computed tomography was performed and contouring was done according to published guidelines. External radiotherapy was followed by Intracavitary brachytherapy delivered to a dose of 9 Gy HDR in 2-fractions, given one week apart. The endpoints were treatment related toxicities and clinical outcomes. Local control (LC), overall survival (OS) and disease free survival (DFS) were evaluated and toxicities were documented using the common terminology criteria for adverse events (v3.0) (CTCAE).
The median follow up time was 37 (range, 19-54) months. The 3 year OS, DFS and LC were 84.2%, 80.6% and 81% respectively. Grade ≥3 acute skin, upper and lower gastrointestinal (GI) and genitourinary (GU) toxicity was observed in 3 (1.4%), 11 (5.2%), 12 (5.7%) and 0 (0%) patients, respectively. Grade ≤2 hematological toxicity was observed in 154 (73.3%) patients. Grade ≥3 late GI and GU toxicity was seen in 9 (4.2%) patients and 2 (0.9%) patients, respectively.
3DCRT with concurrent chemotherapy results in good loco-regional control with acceptable normal tissue toxicity. In the background of indeterminate evidence regarding routine practice of intensity modulated radiotherapy in carcinoma of the cervix, 3DCRT may be considered as the treatment of choice.
本研究旨在回顾性评估接受三维适形放疗（3DCRT）联合同步化疗的局部晚期宫颈癌患者的毒性反应和临床结局。
分析2013年1月至2015年期间210例新诊断的国际妇产科联盟（FIGO）2009分期II - III期局部晚期宫颈癌患者，这些患者接受了3DCRT（46 Gy/23次分割/4.5周）及每周同步顺铂（40 mg/m²）治疗。进行了计划计算机断层扫描，并根据已发表的指南进行了轮廓勾画。外照射放疗后进行腔内近距离放疗，分2次给予9 Gy高剂量率（HDR），间隔1周。观察终点为治疗相关毒性反应和临床结局。评估局部控制（LC）、总生存（OS）和无病生存（DFS）情况，并使用不良事件通用术语标准（第3.0版）（CTCAE）记录毒性反应。
中位随访时间为37（范围19 - 54）个月。3年OS、DFS和LC分别为84.2%、80.6%和81%。分别有3例（1.4%）、11例（5.2%）、12例（5.7%）和0例（0%）患者出现≥3级急性皮肤、上消化道和下消化道（GI）以及泌尿生殖系统（GU）毒性反应。154例（73.3%）患者出现≤2级血液学毒性反应。分别有9例（4.2%）和2例（0.9%）患者出现≥3级晚期GI和GU毒性反应。
3DCRT联合同步化疗可实现良好的局部区域控制，且正常组织毒性可接受。在宫颈癌调强放疗常规应用的证据尚不明确的情况下，3DCRT可被视为首选治疗方法。
