Delanian S, Housset M, Maulard-Durdux C, Taurelle R, Lecuru F, Baillet F
Service d'oncologie-radiothérapie, hôpital Saint-Louis, Paris, France.
Bull Cancer. 1995;82(5):371-6.
We have designed a combined treatment strategy of bifractionated split course radiotherapy (RT) and concomitant chemotherapy (CT) to try to improve the results of RT in inoperable cervical carcinoma. After evaluation, patients were submitted to further radical surgery or additional RT-CT depending on the treatment results. Between January 1988 and January 1992, 25 patients with non metastatic inoperable disease entered in the protocol. The stage of the disease was: T3N0 4 patients, T3 with hydronephrosis seven patients, T3N1 12 patients, and T4N0 two patients. Nineteen patients received two courses of CT with fluorouracil (F), cisplatin (P) with or without etoposide. Pelvic RT was given twice daily (two fractions of 3 Gy) on days 1, 3, 15 and 17. A combination of F 400 mg/m2/d and P 15 mg/m2/d in continuous infusion with oral etoposide (100 mg/d) and hydroxyurea (500 mg/d) in 11 patients was delivered concomitantly on days 1-3 and 14-17. A clinical and radiological evaluation was performed four weeks later. Patients with objective response underwent radical hysterectomy (group A) and those with incomplete response received additional RT-CT protocol (group B). All patients had endocavitary brachytherapy at the end of treatment. After two cycles of CT there were four PR in 19 patients and 5 failures. After RT-CT there were 12 CR (48%) and eight PR. There was a relationship between disease status after RT-CT and response to initial CT in those 19 patients who received the neoadjuvant CT. Fifteen patients were in group A, six of whom had no histologically active disease in the post-operative sample. However all 15 patients were rendered free of disease. Ten patients were in group B, five of whom attained the clinical CR status. In total, 20 of 25 patients (80%) were in CR at the end of treatment. Six patients experienced pelvic recurrence and two patients distant metastases. Four of the five patients with incomplete response had evolutive disease. The overall survival is 60% and 36% at 1 and 2 years respectively after a median follow-up of 22 months (14-48 m). The protocol was tolerable. These results compare favorably with those of conventional RT and warrant further evaluation.
我们设计了一种双分割分段放疗（RT）与同步化疗（CT）相结合的治疗策略，试图提高不可手术宫颈癌的放疗效果。评估后，根据治疗结果，患者接受进一步的根治性手术或额外的放疗-化疗。1988年1月至1992年1月，25例非转移性不可手术疾病患者进入该方案。疾病分期为：T3N0 4例，T3伴肾盂积水7例，T3N1 12例，T4N0 2例。19例患者接受了两疗程含氟尿嘧啶（F）、顺铂（P）加或不加依托泊苷的化疗。盆腔放疗在第1、3、15和17天每天进行两次（每次3 Gy，分两次）。11例患者在第1 - 3天和14 - 17天同时给予F 400 mg/m²/d和P 15 mg/m²/d持续静脉输注，同时口服依托泊苷（100 mg/d）和羟基脲（500 mg/d）。四周后进行临床和影像学评估。客观缓解的患者接受根治性子宫切除术（A组），缓解不完全的患者接受额外放疗-化疗方案（B组）。所有患者在治疗结束时均接受腔内近距离放疗。两周期化疗后，19例患者中有4例部分缓解，5例未缓解。放疗-化疗后有12例完全缓解（48%）和8例部分缓解。在接受新辅助化疗的19例患者中，放疗-化疗后的疾病状态与初始化疗反应之间存在关联。15例患者在A组，其中6例术后标本中无组织学活性疾病。然而，所有15例患者均无疾病。10例患者在B组，其中5例达到临床完全缓解状态。治疗结束时，25例患者中有20例（80%）完全缓解。6例患者出现盆腔复发，2例患者出现远处转移。5例缓解不完全的患者中有4例病情进展。中位随访22个月（14 - 48个月）后，1年和2年的总生存率分别为60%和36%。该方案耐受性良好。这些结果与传统放疗的结果相比具有优势，值得进一步评估。
