Jääskeläinen Ester, Kärkkäinen Henna, Palmgren Jan-Erik, Haataja Marjut, Hinkula Marianne, Anttila Maarit
Department of Gynecology and Obstetrics, Kuopio University Hospital, Kuopio, Finland.
Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
Front Oncol. 2025 May 8;15:1562067. doi: 10.3389/fonc.2025.1562067. eCollection 2025.
External beam radiotherapy with concomitant chemotherapy and image-guided brachytherapy is the standard treatment for locally advanced cervical cancer. This retrospective study compared real-world outcomes with those reported in the literature and evaluated the impact of treatment implementation on the outcomes.
Medical records of consecutive patients receiving radiotherapy for cervical cancer at Kuopio University Hospital from 2009-2018 were examined. We identified 112 patients with a median age of 53 (27-88) years. The International Federation of Gynecology and Obstetrics 2009 classification stages were IB-IVB, 86% had at least stage IIB disease, and 60% had lymph node metastases. External beam radiotherapy was conducted using intensity-modulated radiotherapy or volumetric modulated arc therapy. Concomitant chemotherapy was administered in 90% of cases. All patients received brachytherapy in magnetic resonance imaging guidance. Seventeen patients received neoadjuvant chemotherapy, deviating from the guidelines, while thirteen patients received adjuvant chemotherapy. The patients were divided into two groups according to how precisely the guidelines were followed, considering the delivery of concomitant chemotherapy, the treatment of lymph node metastases, the radiation dose to the primary tumor, and the overall treatment time. The median follow-up time was 58 months (IQR 35-87), and the primary endpoint was 5-year overall survival.
The mean delivered biological dose to the high-risk clinical target volume was 93.7 Gy. The median overall treatment time was 49 days. Overall survival, disease-free survival, and local control at five years were 60.1%, 57.0%, and 85.7%, respectively. Receiving less than three cycles of concomitant chemotherapy was a negative prognostic factor for overall and disease-free survival. The guidelines were adequately followed in 76.8% (Group 1) and substantially deviated from in 23.2% of cases (Group 2). Differences were observed between the groups in 5-year overall survival (67% vs 39%, p=0.016), disease-free survival (62% vs 42%, p=0.040), and lymph node control (84% vs 61%, p=0.007). Neither neoadjuvant chemotherapy nor adjuvant chemotherapy improved the outcome.
The outcomes in this real-world setting were inferior to those reported in the literature. Implementing chemoradiotherapy and brachytherapy according to the guidelines is essential; deviations from the guidelines could worsen the outcome.
外照射放疗联合化疗及图像引导近距离放疗是局部晚期宫颈癌的标准治疗方法。这项回顾性研究比较了实际治疗结果与文献报道的结果，并评估了治疗实施对结果的影响。
对2009年至2018年在库奥皮奥大学医院接受宫颈癌放疗的连续患者的病历进行检查。我们确定了112例患者，中位年龄为53岁（27 - 88岁）。国际妇产科联盟2009年分期为IB - IVB期，86%的患者至少为IIB期疾病，60%有淋巴结转移。外照射放疗采用调强放疗或容积调强弧形放疗。90%的病例给予同步化疗。所有患者均在磁共振成像引导下接受近距离放疗。17例患者接受了新辅助化疗，与指南不符，13例患者接受了辅助化疗。根据同步化疗的实施、淋巴结转移的治疗、原发肿瘤的放射剂量和总体治疗时间对指南的遵循程度，将患者分为两组。中位随访时间为58个月（四分位间距35 - 87个月），主要终点为5年总生存率。
高危临床靶区的平均生物剂量为93.7 Gy。总体治疗时间中位数为49天。5年总生存率、无病生存率和局部控制率分别为60.1%、57.0%和85.7%。接受少于三个周期的同步化疗是总生存和无病生存的不良预后因素。76.8%的病例（第1组）充分遵循了指南，23.2%的病例（第2组）明显偏离了指南。两组在5年总生存率（67%对39%，p = 0.016）、无病生存率（62%对42%，p = 0.040）和淋巴结控制率（84%对61%，p = 0.007）方面存在差异。新辅助化疗和辅助化疗均未改善结局。
在实际临床环境中的治疗结果低于文献报道。按照指南实施放化疗和近距离放疗至关重要；偏离指南可能会使结局恶化。
