Petereit D G, Sarkaria J N, Chappell R, Fowler J F, Hartmann T J, Kinsella T J, Stitt J A, Thomadsen B R, Buchler D A
Department of Human Oncology, University of Wisconsin Medical School, Madison, USA.
Int J Radiat Oncol Biol Phys. 1995 Jul 30;32(5):1301-7. doi: 10.1016/0360-3016(94)00635-X.
Proliferation of surviving tumor clonogens during a course of protracted radiation therapy may be a cause of local failure in cervical carcinoma. The effect of total treatment time was analyzed retrospectively in relation to pelvic control and overall survival for squamous cell carcinomas of the uterine cervix.
Two hundred and nine patients (Stage IB-IIIB) treated with a combination of external beam and low dose rate intracavitary irradiation were evaluable for study. Multivariate analysis and Kaplan-Meier statistical methods were used to determine the effect of treatment time on pelvic control and survival at 5 years.
The median treatment duration was 55 days. For all stages combined, the 5-year survival and pelvic control rates were significantly different with treatment times < 55 days vs. > or = 55 days: 65 and 54% (p = 0.03), 87 and 72% (p = 0.006), respectively. By stage, a shorter treatment duration (i.e., < 55 days vs. > or = 55 days) was significant for 5-year overall survival and pelvic control for Stages IB/IIA and III, but not for Stage IIB: Stage IB/IIA (81 and 67%, 96 and 84%), Stage III disease (52 and 42%, 76 and 55%) and Stage IIB (43 and 50%, 74 and 80%, respectively). Survival decreased 0.6%/day and pelvic control decreased 0.7%/day for each additional day of treatment beyond 55 days for all stages of disease. Additionally, significant late complications were not influenced by treatment time.
These results suggest that prolongation of treatment time is associated with decreased local control and survival in patients with cervical carcinoma. This is consistent with emerging data from other institutions. Therapeutic implications include avoidance of unnecessary treatment breaks, the design of fractionation schemes that decrease treatment duration, and possibly the use of tumor cytostatic drugs during conventional radiation.
在延长疗程的放射治疗过程中，存活肿瘤克隆原细胞的增殖可能是宫颈癌局部治疗失败的一个原因。回顾性分析了总治疗时间对子宫颈鳞状细胞癌盆腔控制和总生存期的影响。
对209例（IB-IIIB期）接受外照射和低剂量率腔内照射联合治疗的患者进行研究评估。采用多因素分析和Kaplan-Meier统计方法确定治疗时间对5年盆腔控制和生存率的影响。
中位治疗持续时间为55天。所有分期综合来看，治疗时间<55天与≥55天相比，5年生存率和盆腔控制率有显著差异：分别为65%和54%（p = 0.03），87%和72%（p = 0.006）。按分期来看，较短的治疗持续时间（即<55天与≥55天相比）对IB/IIA期和III期的5年总生存期和盆腔控制有显著影响，但对IIB期无显著影响：IB/IIA期（81%和67%，96%和84%），III期疾病（52%和42%，76%和55%），IIB期（分别为43%和50%，74%和80%）。对于所有疾病分期，治疗时间超过55天后，每增加一天治疗，生存率下降0.6%/天，盆腔控制率下降0.7%/天。此外，严重晚期并发症不受治疗时间影响。
这些结果表明，治疗时间延长与宫颈癌患者局部控制和生存率降低相关。这与其他机构的新数据一致。治疗意义包括避免不必要的治疗中断，设计缩短治疗持续时间的分割方案，以及可能在常规放疗期间使用肿瘤细胞生长抑制剂。
