Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine Medical Center, Orange, CA, USA.
Department of Radiation Oncology, University of California, San Francisco, CA, USA.
Gynecol Oncol. 2022 Feb;164(2):348-356. doi: 10.1016/j.ygyno.2021.11.015. Epub 2021 Dec 3.
To evaluate the utilization of brachytherapy and duration of treatment on overall survival for locally advanced cervical cancer.
The National Cancer Database (NCDB) was queried to identify stage II-IVA cervical cancer patients diagnosed in the United States between 2004 and 2015 who were treated with definitive chemoradiation therapy. We defined standard of care (SOC) treatment as receiving external beam radiation therapy (EBRT) and concurrent chemotherapy, brachytherapy (BT), and completing treatment within 8 weeks, and compared SOC treatment to non-SOC. The primary outcome was overall survival (OS). We also evaluated the effect of sociodemographic and clinical variables on receiving SOC.
We identified 10,172 women with locally advanced cervical cancer primarily treated with chemotherapy and concurrent EBRT of which 6047 (59.4%) patients received brachytherapy, and only 2978 (29.3%) completed treatment within 8 weeks (SOC). Receipt of SOC was associated with significantly improved overall survival (median OS 131.0 mos vs 95.5 mos, 78.1 mos, 49.2 mos; p < 0.0001). Furthemore, in patients whose treatment extended beyond 8 weeks, brachytherapy was still associated with an improved survival (median OS 95.5 vs 49.2 mos, p < 0.0001). More advanced stage, Non-Hispanic Black race, lower income, lack of insurance or government insurance, less education, and rural residence were associated with decreased likelihood of receiving SOC.
Completing standard of care concurrent chemoradiation therapy and brachytherapy in the recommended 8 weeks was associated with a superior overall survival. Patients who received brachytherapy boost show superior survival to patients receiving EBRT alone, regardless of treatment duration. Disparities in care for vulnerable populations highlight the challenges and importance of care coordination for patients with cervical cancer.
评估近距离放射治疗的应用和治疗持续时间对局部晚期宫颈癌患者总生存期的影响。
本研究在美国国家癌症数据库（NCDB）中查询了 2004 年至 2015 年间确诊为 II-IVA 期宫颈癌并接受根治性放化疗的患者。我们将标准治疗（SOC）定义为接受外照射放疗（EBRT）和同期化疗、近距离放疗（BT），并在 8 周内完成治疗，并将 SOC 治疗与非 SOC 治疗进行比较。主要观察终点为总生存期（OS）。我们还评估了社会人口统计学和临床变量对接受 SOC 治疗的影响。
本研究共纳入 10172 例局部晚期宫颈癌患者，主要接受化疗联合同期 EBRT 治疗，其中 6047 例（59.4%）患者接受了近距离放疗，仅有 2978 例（29.3%）在 8 周内完成治疗（SOC）。接受 SOC 治疗与显著改善的总生存期相关（中位 OS 为 131.0 个月 vs 95.5 个月、78.1 个月和 49.2 个月；p<0.0001）。此外，在治疗时间超过 8 周的患者中，近距离放疗仍与生存改善相关（中位 OS 为 95.5 个月 vs 49.2 个月，p<0.0001）。更晚期的疾病分期、非西班牙裔黑人种族、较低的收入、缺乏保险或政府保险、较低的教育程度和农村居住是 SOC 治疗可能性降低的相关因素。
在推荐的 8 周内完成标准的同步放化疗和近距离放疗与更好的总生存期相关。接受近距离放疗加量的患者的生存优于仅接受 EBRT 的患者，无论治疗持续时间如何。弱势群体的护理差异凸显了宫颈癌患者护理协调的挑战和重要性。
