Sundfør K, Tropé C G, Högberg T, Onsrud M, Koern J, Simonsen E, Bertelsen K, Westberg R
Department of Gynecologic Oncology, Norwegian Radium Hospital, Oslo, Norway.
Cancer. 1996 Jun 1;77(11):2371-8. doi: 10.1002/(SICI)1097-0142(19960601)77:11<2371::AID-CNCR28>3.0.CO;2-T.
The locoregional failure rate remains high in advanced cervical carcinoma. Chemotherapy (CT) was added to radiotherapy (RT) in order to increase disease control and to improve 5-year survival.
CT + RT included cisplatin administered 100mg/m2, d.1 plus 5-fluorouracil 1000 mg/m2 D.1 to 5, ci (120 hrs), q every 3rd week for 3 cycles, followed by RT. RT included external beam irradiation 64.8 Gy in 1.8 Gy fractions, five days a week, by 4-field box technique. The median follow-up was 46 months. Ninety-four patients were evaluable for survival, 47 in the CT + RT group and 47 in the RT group. Ninety-two patients were evaluable for response. Known prognostic factors were equally distributed between the two groups.
Of the 43 patients evaluable before RT, 31 (72%) achieved a partial or complete response after CT alone. After RT, 52 patients attained a complete response, 25 in the CT + RT group and 27 in the RT-group. Sixty-three patients developed distant metastases or local relapse, 30 in the CT + RT group and 33 in the RT group. In the CT + RT group 6 of the 9 patients with metastases also had local progression at relapse, in the RT group, 7 of 17 patients. The survival rates for the two groups are not statistically different. Thirty-seven patients are alive, 29 have no evidence of disease. Fifty-seven have died, 29 in the CT + RT group and 28 in the RT group. Fifty-four deaths were related to cancer, and 3 to therapy.
Sequential CT and RT did not improve the survival, local control, or metastasis rate compared with RT alone.
局部区域复发率在晚期宫颈癌中仍然很高。为了提高疾病控制率和改善5年生存率，在放疗（RT）基础上加用了化疗（CT）。
CT + RT方案包括顺铂100mg/m²，第1天给药，联合5-氟尿嘧啶1000mg/m²，第1至5天持续静脉输注（120小时），每3周重复1次，共3个周期，随后进行放疗。放疗包括采用4野盒式技术，每周5天，每次1.8Gy，分36次给予体外照射，总剂量64.8Gy。中位随访时间为46个月。94例患者可评估生存情况，CT + RT组47例，RT组47例。92例患者可评估疗效。已知的预后因素在两组间分布均衡。
在43例放疗前可评估的患者中，31例（72%）仅化疗后即达到部分或完全缓解。放疗后，52例患者达到完全缓解：CT + RT组25例，RT组27例。63例患者发生远处转移或局部复发：CT + RT组30例，RT组33例。在CT + RT组，9例发生转移的患者中有6例在复发时也有局部进展；在RT组，17例患者中有7例。两组的生存率无统计学差异。37例患者存活，29例无疾病证据。57例患者死亡：CT + RT组29例，RT组28例。54例死亡与癌症相关，3例与治疗相关。
与单纯放疗相比，序贯化疗和放疗并未改善生存率、局部控制率或转移率。
