Christie D R, Bull C A, Gebski V, Langlands A O
Division of Radiation Oncology, Westmead Hospital, Sydney, NSW, Australia.
Radiother Oncol. 1995 Dec;37(3):181-9. doi: 10.1016/0167-8140(95)01648-1.
We reviewed 177 patients treated with radical radiotherapy for locally advanced (FIGO stages IIB, IIIA, IIIB) cervix cancer between January 1979 and December 1989. The radiotherapy was given by external beam treatment to the pelvis and by an intracavitary caesium insertion. Ninety-three patients also received chemotherapy which consisted of infusional 5-fluorouracil during the first and last weeks of the external beam component of the radiotherapy, combined with bolus mitomycin C (group A, 64 patients) or without mitomycin C (group B, 29 patients). These groups were compared with patients treated by radiotherapy alone (group C, 84 patients). The median follow-up was 7.2 years. The median survival time for all patients was 47 months, but was significantly higher (87 months, p = 0.004) for group A. Rates of relapse-free survival and local control were also higher in group A. Toxicity was assessed in detail using the Franco-Italian glossary. There was a relatively high rate of complications, particularly in group A, with 36% of patients having grade 3 or 4 complications. This increase in toxicity persisted through all follow-up time intervals. Patients in group B also demonstrated a higher rate of toxicity than group C, but this increase was limited to the first 6 months of follow-up. The use of mitomycin C in addition to radiotherapy and 5-fluorouracil should be regarded with caution, as other studies have also shown that toxicity is increased, but without improvements in survival.
我们回顾了1979年1月至1989年12月期间接受根治性放疗的177例局部晚期（国际妇产科联盟（FIGO）分期IIB、IIIA、IIIB）宫颈癌患者。放疗采用盆腔外照射和腔内插入铯源的方式。93例患者还接受了化疗，化疗方案为在放疗外照射部分的第一周和最后一周静脉输注5-氟尿嘧啶，联合大剂量丝裂霉素C（A组，64例患者）或不联合丝裂霉素C（B组，29例患者）。将这些组与单纯接受放疗的患者（C组，84例患者）进行比较。中位随访时间为7.2年。所有患者的中位生存时间为47个月，但A组显著更高（87个月，p = 0.004）。A组的无复发生存率和局部控制率也更高。使用法国-意大利语词汇表详细评估毒性。并发症发生率相对较高，尤其是A组，36%的患者出现3级或4级并发症。这种毒性增加在所有随访时间间隔内持续存在。B组患者的毒性发生率也高于C组，但这种增加仅限于随访的前6个月。除放疗和5-氟尿嘧啶外使用丝裂霉素C应谨慎考虑，因为其他研究也表明毒性增加，但生存并未改善。
