Department of Oncology, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China.
Oncology Department, Shanxi Provincial People's Hospital, Shanxi, People's Republic of China.
BMC Cancer. 2023 Sep 26;23(1):905. doi: 10.1186/s12885-023-11406-z.
We aimed to evaluate the clinical efficacy and prognostic significance of intensity-modulated radiotherapy (IMRT)-based salvage concurrent chemoradiotherapy (CCRT) for patients with locoregional recurrence cervical cancer after radical hysterectomy and evaluated two salvage radiotherapy modes-regional RT (involved-field RT combined with regional lymph nodes) and local RT (involved-field RT).
Patients were enrolled retrospectively from January 2011 to January 2022 in three medical centers. Clinical outcomes were analyzed using the Kaplan-Meier method and a Cox proportional hazards model. Propensity score (PS) matching analysis was used to compare the two RT groups.
There were 72 patients underwent IMRT-based salvage CCRT. The 5-year overall survival and progression-free survival rates were 65.9% and 57.6%, respectively. Univariate analysis showed that patients with stump recurrence, a lower systemic inflammation response index (SIRI), only one metastatic lesion, and received regional RT had better prognosis than their counterparts. In multivariate analysis, recurrence site was the independent prognostic factor of OS, and SIRI was that of PFS. After PS matching, there were 15 patients each in the regional RT group and local RT group. The 5-year OS rate of regional RT group was better than that of local RT group (90.9 vs. 42.4, p = 0.021). However, there was no significant difference between them in terms of PFS rate (47.1 vs. 38.1, p = 0.195).
Locoregional recurrent cervical cancer treated with IMRT-based salvage therapy has a good prognosis. Recurrence site and SIRI were independent prognostic factors. Regional RT may be a better option for patients with locoregional recurrent.
评估根治性子宫切除术后局部区域复发宫颈癌患者行调强放疗（IMRT）基础挽救性同步放化疗（CCRT）的临床疗效和预后意义，并评估两种挽救性放疗模式——区域放疗（累及野放疗联合区域淋巴结）和局部放疗（累及野放疗）的效果。
回顾性纳入 2011 年 1 月至 2022 年 1 月在三家医疗中心的患者，采用 Kaplan-Meier 法和 Cox 比例风险模型进行临床结局分析。采用倾向评分（PS）匹配分析比较两组放疗模式。
共纳入 72 例行 IMRT 基础挽救性 CCRT 的患者。5 年总生存率和无进展生存率分别为 65.9%和 57.6%。单因素分析显示，残端复发、较低的全身炎症反应指数（SIRI）、仅有一处转移病灶且行区域放疗的患者预后较好。多因素分析显示，复发部位是总生存的独立预后因素，SIRI 是无进展生存的独立预后因素。PS 匹配后，每组各有 15 例患者。区域放疗组的 5 年 OS 率优于局部放疗组（90.9%比 42.4%，p=0.021）。然而，两组的无进展生存率（47.1%比 38.1%，p=0.195）差异无统计学意义。
采用 IMRT 基础挽救性治疗的局部区域复发性宫颈癌患者预后良好。复发部位和 SIRI 是独立的预后因素。区域放疗可能是局部区域复发患者的更好选择。
