Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
NMHP, Centre of Excellence, Department of Psychiatry, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
J Cancer Res Clin Oncol. 2023 Oct;149(13):12355-12364. doi: 10.1007/s00432-023-05081-7. Epub 2023 Jul 12.
The standard of care for treating early invasive cervical cancer is radical hysterectomy or radiation alone while chemo-radiation is a definitive treatment for advanced disease. Occasionally, a simple hysterectomy is performed in the cancer cervix and these patients merit adjuvant treatment in view of the high chances of loco-regional recurrences. The aim of the study was to analyze the survival outcome of these patients treated with salvage chemo-radiotherapy and also to determine the prognostic factors affecting survival.
The medical records of all patients with cervical cancer post simple hysterectomy outside and who received salvage treatment in our department between 2014 and 2020 were retrieved. The data regarding clinical, treatment details and survival were analyzed.
A total of 198 patients were included. Median follow-up duration was 45.5 months. Gross disease and lymphadenopathy were seen in 60% and 28% patients, respectively. The 5-year progression-free survival(PFS) and overall survival(OS) was 75% and 76%, respectively. Concurrent chemotherapy alone or in combination with induction chemotherapy using three-drug regimens showed better survival compared to those treated by radiation alone. On multivariate analysis, factors found to be adversely affecting OS and PFS were lymph node (LN) size of more than 2 cm, non-squamous histology, overall treatment time(OTT) of more than 12 weeks and use of non three-drug chemotherapy regimen.
Subtotal hysterectomy results in a higher incidence of local recurrence of disease. Factors that impair the outcome in this sub-group of patients are gross lymphadenopathy, non-squamous histology and prolong OTT.
治疗早期浸润性宫颈癌的标准治疗方法是根治性子宫切除术或单纯放疗，而放化疗是晚期疾病的明确治疗方法。偶尔，在宫颈癌中进行单纯子宫切除术，鉴于局部区域复发的高几率，这些患者需要辅助治疗。本研究旨在分析接受挽救性放化疗治疗的这些患者的生存结果，并确定影响生存的预后因素。
检索了 2014 年至 2020 年期间在我院接受单纯子宫切除术和挽救性治疗的所有宫颈癌患者的病历。分析了临床、治疗细节和生存数据。
共纳入 198 例患者。中位随访时间为 45.5 个月。60%的患者有大体疾病，28%的患者有淋巴结病。5 年无进展生存率（PFS）和总生存率（OS）分别为 75%和 76%。单纯同期化疗或联合三药方案诱导化疗的患者的生存情况优于单纯放疗。多因素分析显示，影响 OS 和 PFS 的不利因素包括淋巴结（LN）大于 2cm、非鳞状组织学、总治疗时间（OTT）大于 12 周和非三药化疗方案。
次全子宫切除术导致疾病局部复发的发生率更高。影响这组患者预后的因素是大体淋巴结病、非鳞状组织学和 OTT 延长。
