Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.
Am J Clin Oncol. 2020 Jan;43(1):35-42. doi: 10.1097/COC.0000000000000607.
We examined the impact of brachytherapy boost (BB) and external beam radiotherapy (EBRT) dose-escalation on overall survival (OS) for women with cervical cancer receiving postoperative chemotherapy and radiation (CRT) for a positive margin following hysterectomy.
The National Cancer Database (NCDB) was queried from 2004 to 2015 for women with nonmetastatic squamous cell carcinoma or adenocarcinoma of the cervix who had a positive margin following hysterectomy and received postoperative CRT. Patient and treatment characteristics were assessed with multivariate logistic regression. Survival analyses were performed with univariate Cox regression and Kaplan-Meier analyses. Propensity-score weighted cohorts were generated with inverse probability of treatment weighting via generalized boosted regression modeling.
Of 630 women receiving CRT, 331 (53%) received EBRT alone and 299 (47%) received EBRT+BB. Eighty-two percent had chemotherapy initiation within 2 weeks of radiation, suggesting concurrent delivery. Median EBRT dose was 5040 cGy. Intracavitary high-dose rate was the most common BB (67%). Inclusion of BB was more likely with larger tumor sizes (odds ratio=1.03, P=0.002). Women receiving EBRT+BB had improved OS compared to EBRT alone for both unweighted (hazard ratio [HR], 0.72; P=0.020) and propensity-score weighted cohorts (HR, 0.70; P=0.017), and this finding was consistent across multiple patient subsets. EBRT dose-escalation >5040 cGy was not found to be associated with OS (unweighted HR, 1.38; P=0.065 and weighted HR, 1.16; P=0.450).
The addition of BB to standard CRT improved OS for women with cervical cancer and a positive margin after hysterectomy. No consistent survival benefit was seen to EBRT dose-escalation beyond 5040 cGy.
我们研究了近距离放疗（BB）和外照射放疗（EBRT）剂量递增对接受子宫切除术后化疗和放疗（CRT）的宫颈癌患者总体生存（OS）的影响，这些患者在子宫切除术后因切缘阳性而接受 CRT。
从 2004 年到 2015 年，国家癌症数据库（NCDB）对接受子宫切除术且因切缘阳性而接受术后 CRT 的患有宫颈鳞癌或腺癌的非转移性女性进行了查询。采用多变量逻辑回归评估患者和治疗特征。采用单变量 Cox 回归和 Kaplan-Meier 分析进行生存分析。通过广义增强回归模型进行逆概率治疗加权生成倾向评分加权队列。
在接受 CRT 的 630 名女性中，有 331 名（53%）仅接受 EBRT，299 名（47%）接受 EBRT+BB。82%的患者在放疗后 2 周内开始化疗，提示同时进行。中位 EBRT 剂量为 5040 cGy。腔内高剂量率是最常见的 BB（67%）。肿瘤较大时，更有可能包括 BB（比值比=1.03，P=0.002）。与仅接受 EBRT 的患者相比，接受 EBRT+BB 的患者在未加权（风险比[HR]，0.72；P=0.020）和倾向评分加权队列（HR，0.70；P=0.017）中 OS 均得到改善，这一发现在多个患者亚组中是一致的。未发现 EBRT 剂量递增>5040 cGy 与 OS 相关（未加权 HR，1.38；P=0.065；加权 HR，1.16；P=0.450）。
在子宫切除术后切缘阳性的宫颈癌患者中，BB 联合标准 CRT 可提高 OS。EBRT 剂量递增超过 5040 cGy 并未带来一致的生存获益。
