Rakovitch E, Fyles A W, Pintilie M, Leung P M
Department of Radiation Oncology, Ontario Cancer Institute/Princess Margaret Hospital, University of Toronto, Canada.
Int J Radiat Oncol Biol Phys. 1997 Jul 15;38(5):979-87. doi: 10.1016/s0360-3016(97)00121-1.
To determine if the inclusion of mitomycin C (MMC) in chemoradiation protocols for locally advanced cervical cancer (LACC) significantly enhances the development of serious (Grade 3) late bowel toxicity (SLBT).
The incidence of SLBT in 154 patients with LACC entered in six consecutive chemoradiotherapy protocols between February 1982 and June 1987 was determined. Fifty-four patients who were treated with MMC, 5-fluorouracil (5-FU), and radiation were compared to 100 patients who received similar treatment without MMC. Univariate and multivariate analyses assessed the effect of the following parameters on the development of SLBT: (a) external beam dose, (b) rectal and rectosigmoid dose, (c) paraaortic radiation, (d) intracavitary dose and dose rate, (e) volume of tissue irradiated to a total dose of 60 Gy, (f) International Federation of Gynecology and Obstetrics stage, (g) age, (h) number of courses of 5-FU, (i) previous abdominopelvic surgery, (j) split versus continuous radiation, and (k) administration of MMC.
The overall incidence of SLBT was 15.6%: 14 of 54 (26%) versus 10 of 100 (10%) for patients who did or did not receive MMC, respectively (p = 0.009). Multivariate analysis revealed the administration of MMC as the only factor predictive for the development of SLBT (p = 0.012, odds ratio = 3.15; 95% confidence interval 1.3-7.7). A significant reduction in SLBT was observed with the elimination of MMC from the chemoradiation protocols despite dose escalation of both radiation and 5-FU. No increase in overall survival was observed in patients receiving MMC, 5-FU, and radiation compared with 5-FU and radiation alone.
The inclusion of MMC in these chemoradiation protocols for LACC is associated with significant enhancement in serious late bowel toxicity.
确定在局部晚期宫颈癌（LACC）的放化疗方案中加入丝裂霉素C（MMC）是否会显著增加严重（3级）晚期肠道毒性（SLBT）的发生。
确定了1982年2月至1987年6月期间连续纳入6个放化疗方案的154例LACC患者中SLBT的发生率。将54例接受MMC、5-氟尿嘧啶（5-FU）和放疗的患者与100例接受类似治疗但未使用MMC的患者进行比较。单因素和多因素分析评估了以下参数对SLBT发生的影响：（a）外照射剂量，（b）直肠和直肠乙状结肠剂量，（c）腹主动脉旁放疗，（d）腔内剂量和剂量率，（e）接受60 Gy总剂量照射的组织体积，（f）国际妇产科联盟分期，（g）年龄，（h）5-FU疗程数，（i）既往腹部盆腔手术史，（j）分割放疗与连续放疗，以及（k）MMC的使用。
SLBT的总体发生率为15.6%：接受MMC的患者中54例中有14例（26%），未接受MMC的患者中100例中有10例（10%）（p = 0.009）。多因素分析显示，使用MMC是预测SLBT发生的唯一因素（p = 0.012，比值比 = 3.15；95%置信区间1.3 - 7.7）。尽管放疗和5-FU剂量增加，但从放化疗方案中去除MMC后，观察到SLBT显著降低。与单独使用5-FU和放疗相比，接受MMC、5-FU和放疗的患者总生存期未增加。
在这些LACC的放化疗方案中加入MMC与严重晚期肠道毒性的显著增加相关。
