Nara Katsuhiko, Taguchi Ayumi, Tojima Yuri, Miyamoto Yuichiro, Tanikawa Michihiro, Sone Kenbun, Mori Mayuyo, Tsuruga Tetsushi, Yamamoto Takehito, Takenaka Ryosuke, Takada Tappei, Osuga Yutaka, Suzuki Hiroshi
Department of Pharmacy, The University of Tokyo Hospital, Tokyo, Japan.
Department of Obstetrics and Gynecology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Int J Clin Oncol. 2021 Sep;26(9):1759-1766. doi: 10.1007/s10147-021-01950-8. Epub 2021 Jun 4.
Radiation-based therapy is widely used for advanced cervical cancer. Prior radiation-based therapy is a potential risk factor for febrile neutropenia (FN). However, the effect of irradiation field size on the incidence of FN during recurrent cervical cancer treatment is unclear. This study aimed to investigate the relationship between prior irradiation field size and FN development during recurrent chemotherapy.
This retrospective, observational study included cervical cancer patients who received recurrent chemotherapy between November 2006 and June 2020. The patients were classified into two groups based on the area of irradiation fields. The first group included patients with a history of whole pelvis (WP) irradiation (WP group). The second group had patients who underwent WP plus para-aortic lymph node (PAN) irradiation (WP + PAN group). The incidences of hematological toxicities and FN during the recurrent chemoradiotherapy were compared between the two groups.
The FN incidence was significantly higher in the WP + PAN group than in the WP group (32.1% vs. 0%, P < 0.001). The incidence of Grade 4 neutropenia was not significantly different between the WP + PAN and WP groups. The nadir absolute neutrophil counts were significantly lower and the dose reduction or discontinuation rate of chemotherapy was significantly higher in the WP + PAN group than in the WP group.
History of WP plus PAN radiation is a risk factor for developing FN during recurrent cervical cancer chemotherapy.
基于放疗的治疗方法广泛应用于晚期宫颈癌。既往基于放疗的治疗是发热性中性粒细胞减少症（FN）的一个潜在危险因素。然而，在复发性宫颈癌治疗期间，照射野大小对FN发生率的影响尚不清楚。本研究旨在探讨既往照射野大小与复发性化疗期间FN发生之间的关系。
这项回顾性观察研究纳入了2006年11月至2020年6月期间接受复发性化疗的宫颈癌患者。根据照射野面积将患者分为两组。第一组包括有全盆腔（WP）照射史的患者（WP组）。第二组患者接受了WP加腹主动脉旁淋巴结（PAN）照射（WP + PAN组）。比较两组在复发性放化疗期间血液学毒性和FN的发生率。
WP + PAN组的FN发生率显著高于WP组（32.1%对0%，P < 0.001）。WP + PAN组和WP组4级中性粒细胞减少症的发生率无显著差异。WP + PAN组的中性粒细胞计数最低点显著更低，化疗的剂量减少或停药率显著高于WP组。
WP加PAN放疗史是复发性宫颈癌化疗期间发生FN的一个危险因素。
