Joseph Nuradh, Jayalath Hasanthi, Balawardena Jayantha, Skandarajah Thurairajah, Perera Kanthi, Gunasekera Dehan, Weerasinghe Sujeeva, Hoskin Peter, Choudhury Ananya
General Hospital Chilaw, Ministry of Health, Chilaw, Sri Lanka.
Sri Lanka Cancer Research Group, Maharagama, Sri Lanka.
JCO Glob Oncol. 2020 Oct;6:1574-1581. doi: 10.1200/GO.20.00196.
Radical external-beam radiotherapy (EBRT) followed by intracavitary brachytherapy is standard of care for patients with localized carcinoma of the cervix unsuitable for radical surgery. However, outcome data are scarce in resource-limited settings. We conducted a retrospective analysis of survival in a cohort of patients treated with this strategy in Sri Lanka.
All patients with localized cervical cancer treated with primary EBRT and intracavitary brachytherapy from 2014 to 2015 were included in the study. Primary end point was disease-free survival (DFS), defined as time to local or systemic recurrence or death. Univariable analysis was performed to determine the prognostic significance of the following variables: age, stage, use of concurrent chemotherapy, EBRT dose, brachytherapy dose, and time to completion of treatment (dichotomized at 60 days). Factors significant on univariable analysis were included in a multivariable model.
A total of 113 patients with available data were included in the analysis. Mean age was 58 years (range, 35-85 years), and most patients (n = 103 of 113) presented with stage ≥ IIB disease. Median time to delivery of brachytherapy from commencement of EBRT was 110 days (range, 34-215 days), with only 12 (11%) of 113 patients completing treatment within 60 days. Median follow-up was 28 months (range, 5-60 months), and 2-year DFS was 63.7% (95% CI, 55.4% to 73.2%). Treatment delay was the only significant factor associated with inferior DFS on univariable analysis (log-rank = .03), and therefore, multivariable analysis was not performed.
There are significant delays in receiving intracavitary brachytherapy after completing EBRT for cervical cancer in Sri Lanka, which is associated with inferior DFS. Increasing brachytherapy resources is an urgent priority to improve outcomes of patients with cervical cancer.
对于不适宜进行根治性手术的局限性宫颈癌患者，根治性外照射放疗（EBRT）后行腔内近距离放疗是标准治疗方案。然而，在资源有限的环境中，结局数据稀缺。我们对斯里兰卡采用该策略治疗的一组患者的生存情况进行了回顾性分析。
纳入2014年至2015年接受原发性EBRT和腔内近距离放疗的所有局限性宫颈癌患者。主要终点为无病生存期（DFS），定义为至局部或全身复发或死亡的时间。进行单变量分析以确定以下变量的预后意义：年龄、分期、同步化疗的使用、EBRT剂量、近距离放疗剂量以及治疗完成时间（以60天为界进行二分）。单变量分析中有显著意义的因素纳入多变量模型。
分析共纳入113例有可用数据的患者。平均年龄为58岁（范围35 - 85岁），大多数患者（113例中的103例）表现为≥IIB期疾病。从EBRT开始至进行近距离放疗的中位时间为110天（范围34 - 215天），113例患者中只有12例（11%）在60天内完成治疗。中位随访时间为28个月（范围5 - 60个月），2年DFS为63.7%（95%CI，55.4%至73.2%）。单变量分析中，治疗延迟是与较差DFS相关的唯一显著因素（对数秩检验 = 0.03），因此未进行多变量分析。
在斯里兰卡，宫颈癌患者完成EBRT后接受腔内近距离放疗存在显著延迟，这与较差的DFS相关。增加近距离放疗资源是改善宫颈癌患者结局的当务之急。
