Kushwaha Vandana Singh, Srivastava Kirti, Kumar Sunil, Barik Sandip Kumar
Radiation Oncology, All India Institute of Medical Sciences, Nagpur, Nagpur, IND.
Radiotherapy, King George's Medical University, Lucknow, IND.
Cureus. 2024 Jul 22;16(7):e65154. doi: 10.7759/cureus.65154. eCollection 2024 Jul.
Introduction Chemoradiation (CRT) is the standard of care for the treatment of carcinoma cervix, more benefits of CRT are seen in the early stage as compared to a locally advanced stage. Altered fractionation such as accelerated radiotherapy (ART) in locally advanced carcinoma cervix has not been explored much. Here, we have reported the long-term outcome of ART in comparison to conventional CRT in locally advanced cervical cancer patients. Methods From September 2011 to January 2014, 191 patients with locally advanced squamous cell carcinoma of the uterine cervix, FIGO stage IIB - IIIB were included in this study. They were randomized into two arms: the CRT arm (95 patients) versus the ART arm (96 patients). During external beam radiotherapy (EBRT), the patients in the CRT arm received conventional radiotherapy 50 Gy/25 fractions, 2 Gy/fraction, 5 fractions/week with cisplatin 40 mg/m/week while patients in the ART arm received 50 Gy/25 fractions, 2 Gy/fraction, 6 fractions per week (Monday to Saturday) radiation alone. This was followed by three insertions of 6.5 Gy per fraction of high dose rate (HDR) brachytherapy at one-week intervals in both arms to keep the total treatment time 50 days in the CRT arm versus 45 days in the ART arm. Results The median follow-up of the study population was 57 months (range: 4-108 months). The patients with no residual disease (NRD) after EBRT and complete response (CR) at first follow-up were statistically less in the ART arm as compared to the CRT arm (30.2% versus 53.7% and 42.7% versus 63.2%; p = 0.006 and p = 0.024, respectively). However, there was no statistical difference in response at six months. High-grade acute toxicities hematological (9.5%) and gastrointestinal (15.8%) were more prevalent in the CRT arm in comparison to the ART arm, with no statistical significance (p>0.05) and Grade 1/2 genitourinary toxicity was significantly higher in the CRT arm. Late toxicities in both groups were equivalent. Recurrence, distant type of recurrence, and time to recurrence were similar in both groups. Five-year rates of overall survival (OS) and disease-free survival (DFS) were 51.2% versus 37.2% (p = 0.087) and 57.1% versus 46.3% (p = 0.223) in the CRT arm versus ART arm, respectively. Conclusion ART is a compelling alternative to concurrent chemoradiotherapy for locally advanced cervical cancer, particularly in patients with significant comorbidities, elderly women, and those in higher stages where concurrent chemotherapy's efficacy diminishes. It should be strongly considered when chemotherapy is contraindicated.
引言 放化疗（CRT）是子宫颈癌治疗的标准方案，与局部晚期相比，早期患者接受CRT的获益更多。对于局部晚期子宫颈癌，如加速放疗（ART）等改变分割方式的放疗尚未得到充分探索。在此，我们报告了局部晚期宫颈癌患者中ART与传统CRT相比的长期疗效。方法 2011年9月至2014年1月，本研究纳入了191例FIGO分期为IIB - IIIB期的局部晚期子宫颈鳞状细胞癌患者。他们被随机分为两组：CRT组（95例患者）和ART组（96例患者）。在体外放射治疗（EBRT）期间，CRT组患者接受常规放疗，剂量为50 Gy/25次分割，每次2 Gy，每周5次分割，同时每周给予顺铂40 mg/m，而ART组患者仅接受50 Gy/25次分割，每次2 Gy，每周6次分割（周一至周六）放疗。随后，两组均每隔一周进行3次每次6.5 Gy的高剂量率（HDR）近距离放疗，以使CRT组的总治疗时间为50天，而ART组为45天。结果 研究人群的中位随访时间为57个月（范围：4 - 108个月）。与CRT组相比，ART组在EBRT后无残留疾病（NRD）且首次随访时完全缓解（CR）的患者在统计学上较少（分别为30.2%对53.7%和42.7%对63.2%；p = 0.006和p = 0.024）。然而，六个月时的缓解情况无统计学差异。与ART组相比，CRT组的血液学（9.5%）和胃肠道（15.8%）高级别急性毒性更普遍，无统计学意义（p>0.05），且CRT组1/2级泌尿生殖系统毒性明显更高。两组的晚期毒性相当。两组的复发、远处复发类型及复发时间相似。CRT组与ART组的五年总生存率（OS）分别为51.2%对37.2%（p = 0.087），五年无病生存率（DFS）分别为57.1%对46.3%（p = 0.223）。结论 对于局部晚期宫颈癌，ART是同步放化疗的有力替代方案，尤其对于有严重合并症的患者、老年女性以及同步化疗疗效降低的更高分期患者。当化疗禁忌时，应强烈考虑采用ART。
