Department of Radiation Oncology, University Hospitals of Erlangen, Erlangen, Germany.
Department of Radiation Oncology, Coburg Cancer Center, Coburg, Germany.
Strahlenther Onkol. 2024 Aug;200(8):706-714. doi: 10.1007/s00066-023-02196-1. Epub 2024 Jan 31.
To evaluate clinical results and long-term patient-reported outcome measures (PROMs) on quality of life in cervical cancer patients following radiochemotherapy (RCT) and brachytherapy (BT) as definitive treatment.
Between 2003 and 2023, a total of 132 patients with advanced cervical cancer were evaluated for possible treatment. Patients treated by postoperative RCT, palliative radiotherapy, and those treated for recurrent disease were excluded. Thus, 46 patients receiving standard RCT and BT as their curative treatment were included in this study. PROMs were assessed prospectively by patients' self-completion of the EORTC-QLQ-C30 and EORTC-QLQ-CX24 questionnaires.
Five-year overall survival (OS), distant metastases-free survival (DMFS), and pelvic tumor-free survival rates (PTFS) were 53%, 54%, and 83%, respectively. A significant impact on OS was seen for FIGO (International Federation of Gynecologic Oncology) stage (IIB-IIIA: 79% vs. IIIB-IVA: 33%, p = 0.015), for overall treatment time (OTT; 50-65 d: 64% vs. > 65 d: 38%, p = 0.004), and for rectal D (≤ 73 Gy: 50% vs. > 73 Gy: 38%, p = 0.046). The identical parameters were significantly associated with DMFS (FIGO stage: p = 0.012, OTT: p = 0.008, D: p = 0.024). No parameters with a significant influence on PTFS were seen. In multivariate analysis, an impact of FIGO stage on OS (p = 0.05) and DMFS (p = 0.014) was detected, and of rectal D on DMFS (p = 0.031). The overall QoL score was 63/100. Cognitive function was the least impaired (84/100), while role functioning was the worst (67/100). On the symptom scale, insomnia (46/100), fatigue (41/100), dyspnea (32/100), pain (26/100), and financial difficulties (25/100) were scored the worst. According to EORTC-QLQ-CX24, peripheral neuropathy (36/100) and lymphedema (32/100) occurred most frequently. Impaired sexual/vaginal functioning (32/100) and body image (22/100) were also frequently recorded.
In patients with advanced cervical cancer, a combination of RCT and BT remains an excellent treatment option. In terms of patient-reported long-term quality of life, specific support is needed to alleviate symptoms including lymphedema, peripheral neuropathy, and impaired sexual activity.
评估宫颈癌患者在放化疗（RCT）和近距离放疗（BT）作为根治性治疗后的临床结果和长期患者报告的结局指标（PROMs）对生活质量的影响。
2003 年至 2023 年间，共有 132 名晚期宫颈癌患者接受了可能的治疗评估。排除了接受术后 RCT、姑息性放疗以及治疗复发的患者。因此，46 名接受标准 RCT 和 BT 作为根治性治疗的患者被纳入本研究。通过患者自行完成 EORTC-QLQ-C30 和 EORTC-QLQ-CX24 问卷来前瞻性评估 PROMs。
5 年总生存率（OS）、远处转移无进展生存率（DMFS）和盆腔肿瘤无进展生存率（PTFS）分别为 53%、54%和 83%。FIGO 分期（IIB-IIIA：79%比 IIIB-IVA：33%，p=0.015）、总治疗时间（OTT；50-65d：64%比>65d：38%，p=0.004）和直肠 D 值（≤73Gy：50%比>73Gy：38%，p=0.046）对 OS 有显著影响。相同的参数与 DMFS 显著相关（FIGO 分期：p=0.012，OTT：p=0.008，D：p=0.024）。没有发现对 PTFS 有显著影响的参数。多变量分析显示，FIGO 分期对 OS（p=0.05）和 DMFS（p=0.014）有影响，直肠 D 值对 DMFS 有影响（p=0.031）。总体 QoL 评分为 63/100。认知功能受影响最小（84/100），而角色功能最差（67/100）。在症状量表上，失眠（46/100）、疲劳（41/100）、呼吸困难（32/100）、疼痛（26/100）和经济困难（25/100）评分最差。根据 EORTC-QLQ-CX24，周围神经病变（36/100）和淋巴水肿（32/100）最常发生。性功能/阴道功能障碍（32/100）和身体形象（22/100）也经常受到影响。
在晚期宫颈癌患者中，RCT 和 BT 的联合仍然是一种极好的治疗选择。就患者报告的长期生活质量而言，需要特定的支持来缓解包括淋巴水肿、周围神经病变和性功能障碍在内的症状。
