Lin J C, Ho E S, Jan J S, Yang C H, Liu F S
Department of Radiation Oncology, Taichung Veterans General Hospital, Taiwan, Republic of China.
Gynecol Oncol. 1996 Apr;61(1):101-8. doi: 10.1006/gyno.1996.0105.
A prospective study with a newly designed schedule of concomitant chemoradiotherapy was initiated for 42 patients with previously untreated squamous cell carcinoma of the uterine cervix. Their ages ranged from 34 to 77 years, median 57 years. There were 13 FIGO stage IIB, 1 IIIA, 27 IIIB, and 1 IVA. Radiotherapy was administered using 1.8 Gy/day, 5 days a week, to the whole pelvis (50.4 Gy/28 fractions) with local boost if indicated. Intracavitary brachytherapy of 5 Gy for five times was delivered after 1-2 weeks of rest. The first 21 patients received concomitant chemotherapy of biweekly PEB regimen (100 mg/m2 etoposide + 50 mg/m2 cisplatin + 50 mg/m2 bleomycin) for two to three cycles during external irradiation. The chemotherapy for the latter 21 patients was modified to weekly PEBF (50 mg/m2 etoposide + 20 mg/m2 cisplatin + 10 mg/m2 bleomycin + 800 mg/m2 5-FU, mixed in normal saline, 24-hr continuous iv infusion) for five to six cycles. All except 1 patient achieved complete response (97.6%) and sustain so after a median follow-up time of 30 months. There were three relapses--one with persistent pelvic disease and two with distant metastasis. Two-year overall survival and disease-free survival rates were 97.6 and 92.9%, respectively. Myelosuppression was moderate but fully recovered. Other acute toxicities were tolerated except for 1 patient who encountered grade IV radiation colitis with cecum perforation and required surgery. As to late morbidity, the incidence of radiation proctitis was high (21.4%) but of a mild degree, with 1 patient needing repeated transfusion. One patient developed chronic cystitis with an acontractile bladder. Our preliminary results show that concomitant chemoradiotherapy for advanced cervical carcinoma is both feasible and effective with acceptable toxicities. Further follow-up is mandatory to ensure whether this high complete response protocol will translate into long-term local control and survival.
对42例先前未经治疗的子宫颈鳞状细胞癌患者启动了一项采用新设计的同步放化疗方案的前瞻性研究。患者年龄在34至77岁之间，中位年龄57岁。国际妇产科联盟（FIGO）分期为IIB期13例、IIIA期1例、IIIB期27例、IVA期1例。放疗采用每日1.8 Gy，每周5天，对全盆腔进行照射（50.4 Gy/28次分割），必要时进行局部加量。腔内近距离放疗5 Gy，分5次进行，在休息1至2周后给予。前21例患者在体外照射期间接受每两周一次的PEB方案（100 mg/m²依托泊苷+50 mg/m²顺铂+50 mg/m²博来霉素）同步化疗，共两至三个周期。后21例患者的化疗方案改为每周一次的PEBF（50 mg/m²依托泊苷+20 mg/m²顺铂+10 mg/m²博来霉素+800 mg/m² 5-氟尿嘧啶，溶于生理盐水，24小时持续静脉输注），共五至六个周期。除1例患者外，所有患者均达到完全缓解（97.6%），并在中位随访时间30个月后维持缓解状态。有3例复发——1例为盆腔持续病变，2例为远处转移。两年总生存率和无病生存率分别为97.6%和92.9%。骨髓抑制为中度，但完全恢复。除1例患者发生IV级放射性结肠炎伴盲肠穿孔并需要手术外，其他急性毒性均可耐受。至于晚期并发症，放射性直肠炎的发生率较高（21.4%），但程度较轻，有1例患者需要反复输血。1例患者发生慢性膀胱炎伴膀胱收缩无力。我们的初步结果表明，晚期宫颈癌同步放化疗可行且有效，毒性可接受。必须进行进一步随访，以确保这种高完全缓解方案能否转化为长期的局部控制和生存。
