Pros and Cons of Adding of Neoadjuvant Chemotherapy to Standard Concurrent Chemoradiotherapy in Cervical Cancer: A Regional Cancer Center Experience
Pros and Cons of Adding of Neoadjuvant Chemotherapy to Standard Concurrent Chemoradiotherapy in Cervical Cancer: A Regional Cancer Center Experience
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DOI：
10.1007/s13224-015-0698-5
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发表时间：
2016-10-01
影响因子：
0.7
通讯作者：
Sharma, Ajay
中科院分区：
文献类型：
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作者：
Narayan, Satya;Sharma, Neeti;Sharma, Ajay
本研究总结了巨大的IB 2期和局部晚期（II-IVA期）宫颈鳞状细胞癌的无病生存率和总生存率的治疗结果。治疗的形式是NACT，然后在一个手臂CCRT和CCRT在另一个arm.This回顾性研究分析了713例宫颈癌患者谁在我中心在2007年和2008年期间接受治疗，在713例患者中，612例患者的数据进行了比较。对患者资料进行回顾性分析。患者接受PF 28.6%，TPF 21.5%，仅CCRT 49.9%。大多数患者年龄在41-50岁之间，而分期方面，主要是IIIb和IIb期。根据分期和NACT观察无病生存率。采用Kaplan-Meier法进行生存分析。所有统计学计算均使用SPSS Statistics 20.0版进行。对于宫颈癌NACT与CCRT，5年DFS率为58.3%与41.8%，p = 0.001。与确定性CCRT相比，NACT后CCRT分别显示出显著上级DFS，TPF（风险比（HR）= 0.248，95%置信区间（CI）0.123-0.500; p < 0.001），PF（HR = 0.445，95% CI 0.266-0.722; p = 0.002）。单因素、年龄和多因素研究结果显示，分期血红蛋白水平、腔内外照射间隔时间和新辅助化疗类型是影响宫颈癌放疗患者生存的因素。NACT组的3/4级血液学毒性多于CCRT组（p < 0.001），而非血液学毒性不显著; TPF组的毒性多于PF组（p = 0.029）。这种治疗方案是可行的，NACT的毒性可接受，放疗的依从性高。NACT组的3/4级血液学毒性多于CCRT组（p < 0.001）; TPF组的毒性多于PF组（p = 0.029）。TPF/PF作为NACT是可行的，并且在宫颈癌中产生令人印象深刻的反应。
The present study summarizes the results of treatment in the form of disease-free survival and overall survival in bulky stage IB2 and locally advanced (stages II-IVA) squamous cell carcinoma of the uterine cervix. The treatment has been given in the form of NACT followed by CCRT in one arm and CCRT in the other arm.This retrospective study analyzed 713 cervical cancer patients who were treated at our center during 2007 and 2008; out of 713 patients, data of 612 patients have been compared. The patients' data were analyzed retrospectively. Patients had undergone PF 28.6 %, TPF 21.5 %, and only CCRT 49.9 %. Majority of patients were in the age group 41-50 years, while stage wise, mainly stage IIIb and IIb. Disease-free survival was observed on the basis of stage and NACT. The survival analyses were performed using the Kaplan-Meier method. All statistical calculations were done with SPSS Statistics version 20.0.For cancer cervix NACT versus CCRT, the DFS rate was at 5 years (58.3 vs. 41.8 % p = 0.001). NACT followed by CCRT demonstrated significantly superior DFS as compared to definitive CCRT, respectively, TPF (hazard ratio (HR) = 0.248, 95 % confidence interval (CI) 0.123-0.500; p < 0.001), PF (HR = 0.445, 95 % CI 0.266-0.722; p = 0.002). The results of univariate stage, age, and multivariate study show that stage hemoglobin level, interval between external-intracavitary radiation, and type of neoadjuvant chemotherapy were the factors affected survival cervical patients treated with radiation. The grade 3/4 hematologic toxicities were more in the NACT group than CCRT (p < 0.001) while the non-hematological toxicity was not significant; the TPF group experienced more toxicity than PF (p = 0.029). This treatment regimen is feasible as evidenced by the acceptable toxicity of NACT and by the high compliance to radiotherapy. The grade 3/4 hematologic toxicities were more in NACT groups than CCRT (p < 0.001); the TPF group experienced more toxicity than PF (p = 0.029).TPF/PF as NACT is feasible and produces impressive responses in cancer cervix.