Concurrent carboplatin/5-fluorouracil and radiotherapy for recurrent cervical carcinoma
Concurrent carboplatin/5-fluorouracil and radiotherapy for recurrent cervical carcinoma
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DOI：
10.1023/a:1008356010556
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发表时间：
1999-07-01
影响因子：
50.5
通讯作者：
Mangioni, C
中科院分区：
文献类型：
--
作者：
Maneo, A;Landoni, F;Mangioni, C
背景：即使疾病明显局限于骨盆，手术后复发的宫颈癌患者的挽救治疗结果也令人沮丧。同步放化疗是正在研究的改善这些结果的几种途径之一。患者和方法：35 名患有复发性宫颈癌的女性参加了该试验。 28 名患者（80%）的疾病仅限于中央骨盆（10 名）、侧骨盆（14 名）和阴道（4 名），7 名患者有主动脉旁转移。患者接受外部放疗 (50-70 Gy) 联合三个周期的 5-氟尿嘧啶（第 1-4 天 1000 mg/m(2)/24 小时连续输注）和卡铂（第 1-4 天推注 75 mg/m(2)）的治疗。 结果：治疗耐受性良好，30 名患者 (86%) 按计划完成了治疗方案。急性毒性很严重但可以控制； 11 名患者 (31%) 经历了 3-4 级急性毒性。 5 名患者（14%）出现晚期发病。总体答复率为 74%（11 份部分答复，15 份完整答复）。经过中位随访 27 个月（范围 18-90）后，13 名患者 (37%) 没有患病存活，4 名患者 (11%) 患病持续存在，18 名患者 (52%) 因疾病死亡。整个系列的精算两年生存率为 44%，三年生存率为 25%。原发疾病的分期、复发部位、从初次治疗到复发的时间间隔、淋巴结受累、复发时的输尿管积水和复发时的直径是影响生存的最重要因素，而完全缓解则与复发时的直径和部位以及复发时的淋巴结状态有关。结论：可接受的毒性、高缓解率和令人满意的生存表明卡铂/5-氟尿嘧啶联合放疗是治疗复发性宫颈癌的安全且可耐受的治疗方法癌。需要进一步的研究来证明这种类型的放化疗相对于单独的标准放疗的最终生存益处，并确定特别可能从中受益的患者亚群。
Background: Results of salvage therapy in patients with carcinoma of the uterine cervix recurrent after surgery have been dismal even when the disease was apparently confined to the pelvis. Concurrent chemoradiation is one of the several avenues being investigated to improve these results.Patients and methods: Thirty-five women with recurrent cervical carcinoma were enrolled in the trial. Twenty-eight patients (80%) had disease limited to the central pelvis (ten), lateral pelvis (fourteen) and vagina (four) and seven had paraortic metastases. Patients were treated with a combination of external radiotherapy (50-70 Gy) along with three cycles of 5-fluorouracil (1000 mg/m(2)/24-hour continuous infusion days 1-4) and carboplatin (75 mg/m(2) in bolus days 1-4).Results: Treatment was well tolerated, with 30 patients (86%) completing the protocol as planned. Acute toxicity was severe but manageable; 11 patients (31%) experienced grades 3-4 acute toxicity. Late morbidity occurred in five patients (14%). Overall response rate was 74% (11 partial responses and 15 complete). After a median follow-up of 27 months (range 18-90), 13 patients (37%) are alive without disease, 4 (11%) are alive with persistent disease and 18 (52%) are dead of their disease. Actuarial two-year survival rate for the series as a whole is 44% and three-year survival is 25%. Stage of the primary disease, site of recurrence, interval from the primary therapy to recurrence, lymph node involvement, ureterohydronephrosis at the time of recurrence and diameter of the relapse are the most significant factors for survival, while complete response is related to diameter and site of relapse and lymph node status at the time of relapse.Conclusion: The acceptable toxicity, high response rate and satisfying survival would suggest that concomitant carboplatin/5-fluorouracil and radiotherapy is a safe and tolerable treatment for recurrent cervical carcinoma. Further studies are needed to demonstrate an eventual survival benefit of this type of chemoradiation over standard radiotherapy alone and to identify the subsets of patients who in particular might benefit from this.