Nyamhunga Albert, Ndlovu Ntokozo, Kadzatsa Webster, Morse Gene D, Maponga Charles Chiedza
Department of Oncology, University of Zimbabwe, Harare, Zimbabwe.
Center for Integrated Global Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY.
JCO Glob Oncol. 2020 Oct;6:1554-1564. doi: 10.1200/JGO.19.00412.
Cervical cancer remains the leading cause of cancer morbidity and mortality among Zimbabwean women. Many patients present with stage IIIB disease. Although definitive concurrent chemoradiation (CCRT) is the standard of care, there is a paucity of data on the effect(s) of this intervention in resource-constrained and high HIV-prevalence settings. We investigated the differences in CCRT initiation practices, tolerability, and outcomes in this group.
We performed a retrospective analysis of data from hospital records for patients with stage IIIB disease who were treated over a 2-year period at Parirenyatwa Group of Hospitals. Outcome measures were documented treatment-related adverse events and early clinical tumor response.
One hundred twenty-eight (37%) of 346 patients received CCRT, and 65 (51%) of 128 patients were infected with HIV. CCRT was prescribed mostly in patients with less extensive disease-not involving lower third vaginal walls, minimal pelvic sidewall involvement ( = .002), and higher CD4 count ( = .02). Eighteen percent of recorded adverse events were high grade (≥ 3). One patient did not complete treatment, and 68.5% achieved complete clinical tumor response at 3 months post-CCRT. A higher proportion of complete clinical tumor response was noted in those patients who were young, HIV uninfected, had less extensive disease, CD4 of 500 cells/mm or greater, received four or more cycles of chemotherapy, received brachytherapy, and had no treatment breaks.
The study revealed that the use of CCRT to treat stage IIIB cervical cancer is low in Zimbabwe. Although several factors contribute, low CCRT uptake is mostly attributed to financial barriers. Well-selected patients tolerate the treatment and have good early clinical tumor response as expected. The role of CCRT for this patient group (and methods to make it available in resource-limited settings) must be further evaluated.
宫颈癌仍是津巴布韦女性癌症发病和死亡的主要原因。许多患者就诊时已处于IIIB期疾病。尽管根治性同步放化疗（CCRT）是标准治疗方法，但在资源有限且艾滋病毒高流行率的环境中，关于这种干预效果的数据却很少。我们调查了该组患者在CCRT启动实践、耐受性和结果方面的差异。
我们对在帕里伦亚瓦医院集团接受了为期2年治疗的IIIB期疾病患者的医院记录数据进行了回顾性分析。结果指标记录为与治疗相关的不良事件和早期临床肿瘤反应。
346例患者中有128例（37%）接受了CCRT，128例患者中有65例（51%）感染了艾滋病毒。CCRT大多用于疾病范围较小的患者——未累及阴道下三分之一壁、盆腔侧壁受累最小（P = 0.002）且CD4计数较高（P = 0.02）。记录的不良事件中有18%为高级别（≥3级）。1例患者未完成治疗，68.5%的患者在CCRT后3个月时实现了完全临床肿瘤反应。在年轻、未感染艾滋病毒、疾病范围较小、CD4为500个细胞/mm³或更高、接受四个或更多周期化疗、接受近距离放疗且未中断治疗的患者中，完全临床肿瘤反应的比例更高。
该研究表明，在津巴布韦，使用CCRT治疗IIIB期宫颈癌的比例较低。尽管有几个因素起作用，但CCRT使用率低主要归因于经济障碍。精心挑选的患者能够耐受治疗，并如预期那样有良好的早期临床肿瘤反应。必须进一步评估CCRT对该患者群体的作用（以及在资源有限环境中使其可用的方法）。
