Patterns of treatment failure following radiotherapy with combination chemotherapy for patients with high-risk stage IIB cervical carcinoma.
Patterns of treatment failure following radiotherapy with combination chemotherapy for patients with high-risk stage IIB cervical carcinoma.
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DOI：
10.1007/s10147-003-0378-9
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发表时间：
2004-04-01
影响因子：
3.3
通讯作者：
Kim, Gwi Eon
中科院分区：
文献类型：
--
作者：
Park, Tchan-Kyu;Kwon, Ja-Young;Kim, Gwi Eon
方法：对349例高危因素(病灶大小<4 cm，淋巴结转移，高危细胞类型)的高危因素(病灶大小<4 cm，淋巴结转移，高危细胞类型)接受放疗和顺铂为主化疗的IIB期宫颈癌患者进行回顾性分析。治疗失败的部位被归类为盆腔、盆腔加远处转移和单独远处转移。盆腔衰竭包括局部和盆腔结节衰竭。结果：349例患者中，79例(22.6%)治疗失败。46例(13.2%)为持续性疾病，33例(9.5%)为复发性疾病。在这79名患者中，67%的患者发生盆腔整体衰竭，其中72%为局部衰竭，19%为盆腔结节衰竭，9%为局部盆腔结节衰竭。单纯远处转移和盆腔远处转移的发生率分别为24%和9%。在26例单独或合并盆腔衰竭的远处转移患者中，最常见的转移区域是腹主动脉旁淋巴结(50%)。盆腔肿瘤对照组远处转移率为6.5%(19/289)，盆腔衰竭组为11.6%(7/60)。肿瘤直径大于或等于4 cm组中，盆腔衰竭最常见，而淋巴结阳性组最常见的是远处转移和腹主动脉旁淋巴结转移。高危细胞型患者单纯盆腔功能衰竭和远处转移的发生率相似，远处转移区多为腹主动脉旁淋巴结。结论：全身化疗与放疗同时进行，但在合并高危因素的IIB期宫颈癌放疗联合化疗后，盆腔功能衰竭发生率最高，其次为腹主动脉旁淋巴结转移。目的探讨合并高危因素的IIB期宫颈癌患者放化疗后治疗失败的规律。
BACKGROUND: To evaluate the patterns of treatment failure in patients with stage IIB cervical carcinoma with high-risk factors following radiotherapy given concurrently with combination chemotherapy.METHODS: A retrospective analysis of 349 patients with stage IIB cervical carcinoma with high-risk factors (lesion size >/= 4 cm, lymph node metastasis, high-risk cell type) treated by radiotherapy and cisplatin-based chemotherapy was performed. Sites of treatment failure were categorized as pelvic, pelvic plus distant metastases, and distant metastases alone. Pelvic failure included local and pelvic nodal failures.RESULTS: Of the 349 patients, treatment failure occurred in 79 patients (22.6%). Forty-six (13.2%) had persistent disease and 33 (9.5%) had recurrent disease. Among these 79 patients, overall pelvic failure was observed in 67%, of whom 72% had local failure; 19%, pelvic nodal failure; and 9%, local with pelvic nodal failure. Incidences of distant metastases alone and pelvic with distant metastases were 24% and 9%. In the 26 patients with distant metastases either alone or combined with pelvic failure, the most frequent metastatic region was the paraaortic lymph node (50%). The distant metastasis rate was 6.5% (19/289) in the pelvic tumor control group and 11.6% (7/60) in the pelvic failure group. Pelvic failure was the most frequent failure in the group with tumor size of 4 cm or more, whereas, for the positive-lymph-node group, distant metastasis was most frequent and metastases to paraaortic lymph nodes were common. The incidences of pelvic failure alone and distant metastases were similar in the high-risk cell-type group, and the distant metastasis regions were mostly paraaortic lymph nodes.CONCLUSION: Although systemic chemotherapy was administered concurrently with radiotherapy, the incidence of pelvic failure was highest, followed by paraaortic lymph node metastases, in patients with stage IIB cervical carcinoma with high-risk factors, following radiotherapy with combination chemotherapy. To evaluate the patterns of treatment failure in patients with stage IIB cervical carcinoma with high-risk factors following radiotherapy given concurrently with combination chemotherapy.