Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun, China.
Department of Radiation Oncology, Beijing Cancer Hospital, Beijing, China.
Cancer Control. 2021 Jan-Dec;28:1073274821989307. doi: 10.1177/1073274821989307.
OBJECTIVE: To evaluated the oncologic outcomes associated with platinum-based adjuvant chemotherapy following concurrent chemoradiotherapy (CCRT) in the management of patients with locally advanced cervical cancer (LACC). METHODS: A total of 695 patients with FIGO stage IB2, IIA2, IIB-IVA LACC treated at 6 medical facilities were enrolled and divided into 2 groups: 478 were assigned to CCRT alone (CCRT group) and 217 to adjuvant chemotherapy after CCRT (CCRT-ACT group). The treatment outcomes were retrospectively compared and reported after the propensity score matching (PSM) analysis. RESULTS: With a median follow-up of 56.4 months, no statistically significant differences were found in overall survival (OS), disease-free survival (DFS), progression-free survival (PFS) and distance metastasis-free survival (DMFS) between 2 groups. In CCRT-ACT group, patients with lymph nodes involvement or squamous cell carcinoma (SCC) had significantly longer DMFS, but no significant benefit in survival outcomes were observed with more than 2 cycles of adjuvant chemotherapy. Moreover, patients with a high level of CA125 (>20.5U/mL) or SCC-Ag (>22.8μg/L) had a relatively better DFS or PFS, and grade 3-4 acute hematological toxicity, late urinary and lower gastrointestinal complications and diarrhea symptom were more frequent in CCRT-ACT group. CONCLUSIONS: Adjuvant chemotherapy after CCRT has a potential role in further improving disease control for LACC patients with lymph nodal-metastasis or SCC with a high level of CA125 or SCC-Ag. Due to increased treatment-related complications and diarrhea symptom affecting the quality of life, post-CCRT adjuvant chemotherapy with excessive cycles was not be considered as the most appropriate choice in general.
目的:评估同步放化疗(CCRT)后接受铂类辅助化疗治疗局部晚期宫颈癌(LACC)患者的肿瘤学结局。
方法:共纳入 695 例接受治疗的 FIGO 分期 IB2、IIA2、IIB-IVA LACC 患者,分为两组:478 例患者仅接受 CCRT(CCRT 组),217 例患者在 CCRT 后接受辅助化疗(CCRT-ACT 组)。通过倾向评分匹配(PSM)分析,回顾性比较两组患者的治疗结果。
结果:中位随访 56.4 个月后,两组患者的总生存(OS)、无病生存(DFS)、无进展生存(PFS)和远处转移无复发生存(DMFS)无统计学差异。在 CCRT-ACT 组中,有淋巴结转移或鳞状细胞癌(SCC)的患者 DMFS 明显延长,但辅助化疗超过 2 个周期时,生存结果未见显著获益。此外,CA125 水平较高(>20.5U/mL)或 SCC-Ag 水平较高(>22.8μg/L)的患者DFS 或 PFS 相对较好,且 CCRT-ACT 组中 3-4 级急性血液学毒性、晚期尿和下消化道并发症以及腹泻症状更为常见。
结论:CCRT 后辅助化疗对淋巴结转移或 SCC、CA125 或 SCC-Ag 水平较高的 LACC 患者有进一步改善疾病控制的作用。但由于治疗相关并发症增加和腹泻症状影响生活质量,一般不考虑辅助化疗过多周期作为最佳选择。
Cochrane Database Syst Rev. 2014-12-3
Cochrane Database Syst Rev. 2022-8-22
Technol Cancer Res Treat. 2022
Cancer Epidemiol Biomarkers Prev. 2019-4-3