Department of radiation oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
Radiat Oncol. 2018 Nov 20;13(1):223. doi: 10.1186/s13014-018-1172-1.
Currently, the standard treatment for locally advanced cervical cancer patients is concurrent chemoradiotherapy. Here we aim to evaluate therapeutic efficacy, treatment failure, toxicity and prognostic factors for FIGO IIIB cervical cancer patients.
A comprehensive retrospective analysis was performed to understand various factors which contribute to IIIB cervical cancer prognosis. In total 223 well defined patients were assigned according to their pathological subtype, age, pre-treatment HGB level, tumor size, pelvic lymph node (LN) metastasis, para-aortic LN metastasis as well as external irradiation technologies, treatment duration, point A EQD2 dose and concurrent chemotherapy cycles. We then performed correlation studies of these factors and OS, DFS, LCR, DMFS using univariate and multivariate analysis respectively.
We managed to achieve 207 (92.8%) complete response (CR) and 16 (7.2%) partial response (PR) with acceptable adverse effects. Notably, the 5 years OS, DFS, LCR, DMFS for these patients were 61.1, 55.2, 83.6 and 66.4% respectively. Importantly, our studies suggest that escalated point A EQD2 can significantly improve OS, DFS and LCR for FIGO IIIB cervical cancer patients, furthermore, patients without para-aortic LN metastasis who received prophylactic extended field irradiation have significant survival advantage for DFS and a tendency to improve OS and DMFS.
Our results suggest that FIGO IIIB cervical cancer patients should receive higher EQD2 (≥98Gy) radiotherapy, moreover, patients without para-aortic LN metastasis should receive prophylactic extended field nodal irradiation to improve prognosis.
目前，局部晚期宫颈癌患者的标准治疗方法是同期放化疗。我们旨在评估 FIGO IIIB 宫颈癌患者的治疗效果、治疗失败、毒性和预后因素。
对 223 例明确诊断的患者进行了全面的回顾性分析，以了解影响 IIIB 宫颈癌预后的各种因素。根据病理亚型、年龄、治疗前 HGB 水平、肿瘤大小、盆腔淋巴结（LN）转移、腹主动脉旁 LN 转移以及外照射技术、治疗时间、A 点 EQD2 剂量和同期化疗周期对患者进行分组。然后分别采用单因素和多因素分析方法对这些因素与 OS、DFS、LCR、DMFS 的相关性进行了研究。
我们取得了 207 例（92.8%）完全缓解（CR）和 16 例（7.2%）部分缓解（PR），且不良反应可接受。值得注意的是，这些患者的 5 年 OS、DFS、LCR 和 DMFS 分别为 61.1%、55.2%、83.6%和 66.4%。重要的是，我们的研究表明，升高的 A 点 EQD2 可显著提高 FIGO IIIB 宫颈癌患者的 OS、DFS 和 LCR，此外，未发生腹主动脉旁 LN 转移且接受预防性扩展野照射的患者在 DFS 方面具有显著的生存优势，且 OS 和 DMFS 有改善的趋势。
我们的结果表明，FIGO IIIB 宫颈癌患者应接受更高的 EQD2（≥98Gy）放疗，此外，无腹主动脉旁 LN 转移的患者应接受预防性扩展野淋巴结照射以改善预后。
