Tian Xue, Yang Feiyue, Li Fenghu, Ran Li, Chang Jianying, Li Jiehui, Hong Wei, Shan Lang, Du Yanjun, Hu Lili, Mei Fan, He Mingyuan, Li Yongxia, Wang Heran, Zuo Kai, Zhou Bo, Chen Shuying, Mao Wanli
Department of Oncology, The Affiliated Hospital of Guizhou Medical University, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China.
Department of Gynecologic Oncology, Guizhou Provincial People's Hospital, Guiyang, 550004, People's Republic of China.
Cancer Manag Res. 2021 Nov 3;13:8307-8316. doi: 10.2147/CMAR.S328309. eCollection 2021.
To examine the clinical significance of unoperated cervical cancer patients treated with different neoadjuvant chemotherapy (NACT) schemes followed by concurrent chemotherapy and radiotherapy (CCRT).
This retrospective analysis included women with locally advanced cervical cancer treated with NACT-CCRT between September 2011 and September 2014. Neoadjuvant chemotherapy included paclitaxel plus cisplatin (TP group; 62 patients) or paclitaxel plus loplatin (TL group; 58 patients), which were administered three weekly, and cisplatin or loplatin, which were administered weekly for synchronous chemotherapy. External beam radiation therapy (50.4-56.35 Gy/28 f, 180-215 cGy/f, 5 f/w) was followed by intracavitary brachytherapy (5 Gy per fraction, mostly 5 fractions, Ir192 based).
One hundred twenty women were included in the analysis. The complete/partial response rate was 99.2% after treatment. The one-year, three-year, and five-year survival rates were 99.2%, 82.5%, and 70.8%, respectively. In the TP and TL groups, the three-year and five-year survival rates were 85.5% vs 77.6% and 75.8% vs 65.5%, respectively, with no significant difference. The 5-year overall survival (OS) rates between patients with stage IIB and stage IIIB disease were not significantly different (69.2% vs 64.7%). In the TP group, grade 3 or 4 digestive reactions were more frequent than those in the TL group. Leukopenia, neutropenia, and thrombocytopenia were more common in the TL group. No significant difference was found in anemia, radiation enteritis, radiation proctitis, or radiation cystitis between the groups.
Lobaplatin may be used as an alternative drug for patients with severe digestive system reactions or contraindications to cisplatin, but hematological toxicity must be considered, particularly in dose-intensive schemes. Neoadjuvant chemotherapy followed by concurrent chemotherapy and radiotherapy (NACT-CCRT) warrants further prospective study in cervical cancer patients with a wide range of tumor invasion (eg, mass size ≥5 cm or stage IIIB).
探讨未接受手术治疗的宫颈癌患者采用不同新辅助化疗（NACT）方案后序贯同步放化疗（CCRT）的临床意义。
本回顾性分析纳入了2011年9月至2014年9月期间接受NACT-CCRT治疗的局部晚期宫颈癌女性患者。新辅助化疗包括紫杉醇联合顺铂（TP组；62例患者）或紫杉醇联合洛铂（TL组；58例患者），每3周给药1次，同步化疗采用顺铂或洛铂每周给药1次。外照射放疗（50.4 - 56.35 Gy/28次，180 - 215 cGy/次，5次/周）后行腔内近距离放疗（每次5 Gy，大多为5次，基于Ir192）。
120名女性纳入分析。治疗后完全/部分缓解率为99.2%。1年、3年和5年生存率分别为99.2%、82.5%和70.8%。TP组和TL组的3年和5年生存率分别为85.5%对77.6%和75.8%对65.5%，差异无统计学意义。IIB期和IIIB期疾病患者的5年总生存率无显著差异（69.2%对64.7%）。TP组3/4级消化系统反应比TL组更频繁。TL组白细胞减少、中性粒细胞减少和血小板减少更常见。两组在贫血、放射性肠炎、放射性直肠炎或放射性膀胱炎方面未发现显著差异。
对于有严重消化系统反应或顺铂禁忌证的患者，洛铂可作为替代药物，但必须考虑血液学毒性，尤其是在剂量密集方案中。新辅助化疗后序贯同步放化疗（NACT-CCRT）在肿瘤侵犯范围广泛（如肿块大小≥5 cm或IIIB期）的宫颈癌患者中值得进一步进行前瞻性研究。
