Donath S, Schirmer M A, Bremmer F, Seif A, Dröge L H, Guhlich M, Fischer L A, Ziegler D A, Ziegler S, Leu M, Pagel C F, Zwerenz C M, Oelmann J T, El Shafie R, Hille A, Ammon H E, Fleckenstein G, Hess C F, Rieken S, Bendrich S
Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
Comprehensive Cancer Center Göttingen (G-CCC), Universitätsmedizin Göttingen, Robert-Koch-Straße40, 37075, Göttingen, Germany.
Strahlenther Onkol. 2025 May;201(5):537-545. doi: 10.1007/s00066-024-02340-5. Epub 2025 Jan 8.
Neoadjuvant radiochemotherapy (NARCT) is an established standard of care in various tumor entities, promoting high response rates at commonly lower toxicities as compared to adjuvant approaches. This retrospective analysis was designed to investigate NARCT in early-stage high-risk cervical cancer.
Forty patients with early-stage high-risk cervical cancer (i.e., L1, V1, G3, N+, > / stromal invasion, > 4 cm tumor size, borderline resectability) were treated with NARCT prior to surgical resection. Downstagings based on clinical, imaging, and pathological responses were recorded. Survival rates were calculated according to Kaplan-Meier, and prognostic factors were analyzed with uni- and multivariable Cox regression analyses using SPSS software (v. 26; IBM Corp., Armonk, NY, USA).
Both NARCT and subsequent tumor resection were feasible and conducted in 39 of 40 patients (95%). Early toxicity was moderate, with no grade 3 or higher toxicities following NARCT and surgery. NARCT yielded significant downstaging in all patients, and pathological complete remission (pCR) was achieved in 14 patients (36%). After 5 years, overall survival (OS), freedom from local progression (FFLP), and freedom from distant progression (FFDP) rates were 84.2%, 75.9%, and 73.1%, respectively. Late proctitis (grade 1 in 8%) and urinary cystitis (grade 1-3 in 35%) occurred at acceptable rates.
In resectable early-stage high-risk cervical cancer, NARCT is feasible and safe. Clinical, imaging, and pathological response rates are high. Impressive long-term survival and tumor control rates at modest toxicities encourage the initiation of a prospective and randomized trial.
新辅助放化疗（NARCT）是多种肿瘤实体公认的标准治疗方法，与辅助治疗方法相比，通常在毒性较低的情况下能实现较高的缓解率。本回顾性分析旨在研究早期高危宫颈癌的新辅助放化疗。
40例早期高危宫颈癌患者（即L1、V1、G3、N+、> / 间质浸润、肿瘤大小>4 cm、边界可切除性）在手术切除前接受了新辅助放化疗。记录基于临床、影像学和病理反应的降期情况。根据Kaplan-Meier法计算生存率，并使用SPSS软件（v. 26；IBM公司，美国纽约州阿蒙克）通过单变量和多变量Cox回归分析来分析预后因素。
新辅助放化疗及随后的肿瘤切除均可行，40例患者中有39例（95%）完成了治疗。早期毒性为中度，新辅助放化疗和手术后无3级或更高等级的毒性反应。新辅助放化疗使所有患者均出现显著降期，14例患者（36%）实现了病理完全缓解（pCR）。5年后，总生存率（OS）、无局部进展生存率（FFLP）和无远处进展生存率（FFDP）分别为84.2%、75.9%和73.1%。晚期直肠炎（8%为1级）和膀胱炎（35%为1 - 3级）的发生率在可接受范围内。
在可切除的早期高危宫颈癌中，新辅助放化疗是可行且安全的。临床、影像学和病理缓解率较高。在毒性适中的情况下，令人印象深刻的长期生存率和肿瘤控制率鼓励开展一项前瞻性随机试验。
