Cervical carcinoma metastatic to para-aortic nodes: Extended field radiation therapy with concomitant 5-fluorouracil and cisplatin chemotherapy: A Gynecologic Oncology Group Study
Cervical carcinoma metastatic to para-aortic nodes: Extended field radiation therapy with concomitant 5-fluorouracil and cisplatin chemotherapy: A Gynecologic Oncology Group Study
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DOI：
10.1016/s0360-3016(98)00267-3
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发表时间：
1998-12-01
影响因子：
7
通讯作者：
Connelly, P
中科院分区：
文献类型：
--
作者：
Varia, MA;Bundy, BN;Connelly, P
目的：一项多中心放化疗试验，旨在评估5-氟尿嘧啶（5-FU）和顺铂联合扩大野放疗（ERT）的可行性，并确定活检证实的宫颈癌主动脉旁淋巴结转移（PAN）患者的无进展间期（PFI）、总生存期（OS）和复发部位。方法和材料：入组了95例宫颈癌和PAN转移患者，86例可评价：I期-14例，II期-40例，III期-27例，IVA期-5例。79%的患者随访5年或更长时间或死亡。ERT剂量为4500 cGy（PAN），骨盆3960 cGy（IB/IIB期），骨盆4860 cGy（IIIB/IVA期）。A点腔内（IC）剂量为4000 cGy（IB/IIB期）和3000 cGy（IIIB/IVA期）。B点剂量增加至6000 cGy（ERT + IC），同时进行宫旁加强。同期化疗方案为5-FU 1000 mg/m2/d × 96 h，顺铂50 mg/m2，第1、5周。结果：86例患者中85例完成放疗，90%完成两个疗程。妇科肿瘤组（GOG）3-4级急性毒性为胃肠道（18.6%）和血液学（15.1%）。4年时的晚期发病率精算风险为14%，主要涉及直肠。初始复发部位为盆腔，20.9%;仅远处转移，31.4%;盆腔+远处转移，10.5%。整个组的3年OS和PFI率分别为39%和34%。结论：5-FU联合顺铂扩大野放疗是一种可行的多中心临床试验。3年时PFI为33%，表明一部分患者控制了晚期盆腔疾病，并非所有PAN转移患者都有全身性疾病。这表明评估和治疗PAN转移的重要性。(C)1998年爱思唯尔科学公司
Purpose: A multicenter trial of chemoradiation therapy to evaluate the feasibility of extended field radiation therapy (ERT) with 5-fluorouracil (5-FU) and cisplatin, and to determine the progression-free interval (PFI), overall survival (OS), and recurrence sites in patients with biopsy-confirmed para-aortic node metastases (PAN) from cervical carcinoma.Methods and Materials: Ninety-five patients with cervical carcinoma and PAN metastases were entered and 86 were evaluable: Stage I-14, Stage II-40, Stage III-27, Stage IVA-5. Seventy-nine percent of the patients were followed for 5 or more years or died. ERT doses were 4500 cGy (PAN), 3960 cGy to the pelvis (Stages IB/IIB), and 4860 cGy to the pelvis (Stages IIIB/IVA). Point A intracavitary (IC) doses were 4000 cGy (Stages IB/IIB), and 3000 cGy (Stages IIIB/IVA). Point B doses were raised to 6000 cGy (ERT + IC) with parametrial boost. Concomitant chemotherapy consisted of 5-FU 1000 mg/m(2)/day for 96 hours and cisplatin 50 mg/m(2) in weeks 1 and 5.Results: Eighty-five of 86 patients completed radiation therapy and 90% of patients completed both courses of chemotherapy. Gynecologic Oncology Group (GOG) grade 3-4 acute toxicity were gastrointestinal (18.6%) and hematologic (15.1%). Late morbidity actuarial risk of 14% at 4 years primarily involved the rectum. Initial sites of recurrence were pelvis alone, 20.9%; distant metastases only, 31.4%; and pelvic plus distant metastases, 10.5%. The 3-year OS and PFI rate were 39% and 34%, respectively, for the entire group. OS was Stage I-50%, Stage II-39%, and Stage III/IVA-38%.Conclusions: Extended field radiation therapy with 5-FU and cisplatin chemotherapy was feasible in a multicenter clinical trial. PFI of 33% at 3 years suggests that a proportion of patients achieve control of advanced pelvic disease and that not all patients with PAN metastases have systemic disease. This points to the importance of assessment and treatment of PAN metastases. (C) 1998 Elsevier Science Inc.