Mailankody Sharada, Dhanushkodi Manikandan, Ganesan Trivadi S, Radhakrishnan Venkatraman, Christopher Vasanth, Ganesharajah Selvaluxmy, Sagar Tenali Gnana
Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai 600020, India.
Department of Medical Oncology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, India.
Ecancermedicalscience. 2020 Oct 13;14:1122. doi: 10.3332/ecancer.2020.1122. eCollection 2020.
Cervical cancer is the third most common cancer in India. There is limited data on the treatment of relapsed cervical cancer from India; therefore, we report the outcomes of patients with recurrent cervical cancer who were treated with palliative chemotherapy (CT).
This was a retrospective study of patients with recurrent cervical cancer who received palliative CT from January 2012 to December 2016. The demographic details, clinical profile and survival outcomes were collected. Patients were treated with carboplatin or paclitaxel and carboplatin. Local radiation was given for symptomatic patients. Patients were assessed for responses clinically and/or radiologically after three and six cycles of CT. Progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan-Meier method.
Forty-six patients with recurrent cervical cancer were included in this analysis, with a median follow-up of 9.4 months. The median age was 49.5 (25-65) years and the median disease-free interval was 31.3 (2-196) months. Biopsy confirmation of relapse was established in 63%. The median number of CT cycles was six. Twenty-four (52.2%) patients completed six cycles of CT. The overall response rate was 56.5%. Patients with a complete or a partial response were more likely to have PFS > 6 months ( < 0.0001). Median PFS and OS were, respectively, 8.4 (95% CI 6.1-10.7) months and 10.3 (95% CI 6.8-13.8) months. The completion of all cycles of CT and the site of metastasis (nodal vs. visceral or combined) were found to be associated with OS.
Palliative CT with paclitaxel carboplatin is a safe and effective option in Indian patients with recurrent cervical cancer, with more than half of the patients completing the prescribed CT. Further prospective trials may be required to place this treatment in the right context, in this era of immunotherapy and targeted therapy. However, knowing the outcomes in our population and prognostic factors will help in better prognostication of patients, thereby channelling our limited resources where necessary.
宫颈癌是印度第三大常见癌症。关于印度复发性宫颈癌治疗的数据有限；因此，我们报告接受姑息化疗（CT）的复发性宫颈癌患者的治疗结果。
这是一项对2012年1月至2016年12月期间接受姑息性CT治疗的复发性宫颈癌患者的回顾性研究。收集了人口统计学细节、临床特征和生存结果。患者接受卡铂或紫杉醇加卡铂治疗。对有症状的患者进行局部放疗。在CT治疗三个周期和六个周期后，对患者进行临床和/或放射学反应评估。使用Kaplan-Meier方法计算无进展生存期（PFS）和总生存期（OS）。
本分析纳入了46例复发性宫颈癌患者，中位随访时间为9.4个月。中位年龄为49.5（25 - 65）岁，中位无病间期为31.3（2 - 196）个月。63%的患者经活检确诊复发。CT周期的中位数为六个。24例（52.2%）患者完成了六个周期的CT治疗。总缓解率为56.5%。完全或部分缓解的患者更有可能出现PFS>6个月（<0.0001）。中位PFS和OS分别为8.4（95%CI 6.1 - 10.7）个月和10.3（95%CI 6.8 - 13.8）个月。发现完成所有CT周期以及转移部位（淋巴结转移与内脏转移或联合转移）与OS相关。
对于印度复发性宫颈癌患者，紫杉醇加卡铂的姑息性CT是一种安全有效的选择，超过一半的患者完成了规定的CT治疗。在这个免疫治疗和靶向治疗的时代，可能需要进一步的前瞻性试验来正确定位这种治疗方法。然而，了解我们人群中的治疗结果和预后因素将有助于更好地对患者进行预后评估，从而在必要时合理分配我们有限的资源。
