Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands.
Gynaecology, Leiden University Medical Center, Leiden, The Netherlands.
Int J Gynecol Cancer. 2020 Dec;30(12):1878-1886. doi: 10.1136/ijgc-2019-001131. Epub 2020 Jun 25.
The aim of this study was to assess the impact of the evolving role of the addition of chemotherapy to postoperative radiotherapy on oncological outcomes and toxicity in patients with early-stage cervical cancer after radical hysterectomy.
Retrospective cohort study of patients with stage IB1-IIB FIGO 2009 cervical cancer treated from November 1999 to May 2015 by primary surgery and radiotherapy (46-50.4 Gy in 1.8-2.0 Gy fractions) with or without concurrent cisplatin (40 mg/m, 5-6 weekly cycles) with or without a brachytherapy boost. Chemotherapy was allocated depending on the risk factors for recurrence. Incidences of all outcomes were calculated using Kaplan-Meier's methodology and compared by log-rank tests. Risk factors for recurrence and survival were identified using Cox's proportional hazards models.
A total of 154 patients were included, median follow-up was 9.6 years (IQR: 6.1-12.8). Five-year pelvic recurrence-free survival was 75.3%; 74.7% in patients with high-risk factors treated with radiotherapy; and 77.3% in those treated with chemoradiation (P=0.43). Distant metastasis-free survival at 5 years was 63.4%; 63.6% in high-risk patients after radiotherapy; and 57.1% after chemoradiation (P=0.36). Five-year overall survival was 63.9%: 66.8% and 51.6% after radiotherapy and after chemoradiation in patients with high-risk factors (P=0.37), respectively. Large tumor size was a risk factor for vaginal and pelvic recurrence, ≥2 involved lymph nodes was a significant risk factor for para-aortic recurrence and death. Mild treatment-related late toxicity was observed in 53.9% of the patients. Five-year severe (grade 3-5) late rectal, bladder, bowel, and vaginal toxicities were, respectively, 1.3%, 0%, 3.4%, and 0.9%. Any late severe toxicity was observed in 5.5% of patients treated with radiotherapy and in 15.3% of those treated with chemoradiation (P=0.07).
Postoperative (chemo)radiation for early-stage cervical cancer patients with risk factors for recurrence yields adequate pelvic tumor control, but overall survival is limited due to distant metastasis.
本研究旨在评估在根治性子宫切除术后，化疗在术后放疗中的作用不断演变，对早期宫颈癌患者的肿瘤学结果和毒性的影响。
本研究是一项回顾性队列研究，纳入了 1999 年 11 月至 2015 年 5 月期间接受根治性子宫切除术和放疗（46-50.4Gy，1.8-2.0Gy 分野）的 FIGO 2009 分期为 IB1-IIB 期宫颈癌患者，其中部分患者同时接受顺铂（40mg/m，5-6 个周期）治疗，部分患者接受外照射联合近距离放疗。化疗的分配取决于复发的危险因素。采用 Kaplan-Meier 方法计算所有结局的发生率，并采用对数秩检验进行比较。采用 Cox 比例风险模型确定复发和生存的危险因素。
共纳入 154 例患者，中位随访时间为 9.6 年（IQR：6.1-12.8）。5 年盆腔无复发生存率为 75.3%；高危因素患者接受放疗者为 74.7%，接受放化疗者为 77.3%（P=0.43）。5 年远处无转移生存率为 63.4%；高危患者接受放疗者为 63.6%，接受放化疗者为 57.1%（P=0.36）。5 年总生存率为 63.9%：高危患者中，接受放疗者为 66.8%，接受放化疗者为 51.6%（P=0.37）。肿瘤较大是阴道和盆腔复发的危险因素，≥2 个淋巴结受累是腹主动脉复发和死亡的显著危险因素。53.9%的患者出现轻度治疗相关晚期毒性。5 年严重（3-5 级）晚期直肠、膀胱、肠和阴道毒性发生率分别为 1.3%、0%、3.4%和 0.9%。接受放疗的患者中，有 5.5%发生任何严重的晚期毒性，而接受放化疗的患者中，有 15.3%发生（P=0.07）。
对于有复发危险因素的早期宫颈癌患者，术后（放）化疗可获得足够的盆腔肿瘤控制，但由于远处转移，总体生存率有限。
