FIGO IIIB squamous cell carcinoma of the cervix: An analysis of prognostic factors emphasizing the balance between external beam and intracavitary radiation therapy
FIGO IIIB squamous cell carcinoma of the cervix: An analysis of prognostic factors emphasizing the balance between external beam and intracavitary radiation therapy
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DOI：
10.1016/s0360-3016(98)00482-9
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发表时间：
1999-03-01
影响因子：
7
通讯作者：
Eifel, PJ
中科院分区：
文献类型：
--
作者：
Logsdon, MD;Eifel, PJ
目的：探讨影响FIGO IIIB期完整子宫颈鳞状细胞癌预后的患者、肿瘤和治疗因素。方法与材料：回顾性分析1960 ~ 1993年接受放射治疗的1096例FIGO IIIB期完整子宫颈鳞状细胞癌患者的资料。其中，983例（90%）以治愈为目的接受治疗，113例仅为缓解症状而接受治疗。在907名完成预期治疗的患者中，641名（71%）患者接受了外束照射（EBRT）和腔内照射（ICRT）的联合治疗，266名（29%）患者仅接受了EBRT治疗。907例患者的中位治疗持续时间为51天。1966年至1980年期间，完成治疗的患者中只有52%接受了ICRT，而1981年至1993年期间接受治疗的患者中有92%接受了ICRT，这一增长反映了晚期肿瘤治疗理念的演变。一般来说，ICRT的强度与EBRT对骨盆中央的剂量呈负相关。存活患者的中位随访时间为134个月。结果：在983例以初始治愈意图接受治疗的患者中，年龄< 40岁、体重减轻超过10%或在放疗前或放疗期间血红蛋白水平< 10 g/dl的患者的疾病特异性生存率（DSS）明显更差。与DSS相对较差相关的肿瘤因素为双侧盆腔壁受累、临床肿瘤直径大于等于8cm、肾积水、下阴受累、淋巴管造影显示淋巴结转移（所有病例p < 0.01）。907例以治愈目的完成治疗的患者中，641例接受ICRT治疗的患者5年时的DSS为45%，而单独接受EBRT治疗的患者为24% （p < 0.0001）。接受bbb52 Gy EBRT中央骨盆治疗的患者DSS率为27-34%，而接受较低剂量EBRT中央骨盆治疗和强化ICRT治疗的患者为53% （p < 0.0001）。5年时，与接受48-52 Gy EBRT治疗的患者（28%）和接受小于或等于47 Gy EBRT治疗的患者（15%）相比，接受中央骨盆EBRT治疗的患者（57-68%）发生主要并发症的精算风险也更高（p < 0.0001）。结果还比较了四个时期，在此期间，对IIIB期疾病患者采用了不同的治疗政策。在最近一段时间（1981-1993年），当适度剂量的EBRT与相对强化的ICRT联合使用时，DSS最高（51%），精算并发症发生率最低（17%）（两种比较p < 0.01）。结论：对于FIGO IIIB期宫颈癌患者，积极应用ICRT，并与盆腔EBRT谨慎平衡，以达到肿瘤控制和并发症的最佳比例。根据我们的经验，40-45 Gy EBRT联合ICRT可获得最高的DSS率和最低的并发症率。(C) 1999 Elsevier Science Inc.；
Purpose: To define patient, tumor, and treatment factors that influence the outcome of patients with FIGO Stage IIIB squamous cell carcinoma of the intact uterine cervix.Methods and Materials: The records of 1,096 patients treated with radiation therapy between 1960 and 1993 for FIGO Stage IIIB squamous cell carcinoma of the intact uterine cervix were reviewed retrospectively. Of these, 983 (90%) were treated with curative intent and 113 were treated only to achieve palliation of symptoms. Of 907 patients who completed the intended curative treatment, 641 (71%) were treated with a combination of external beam irradiation (EBRT) and intracavitary irradiation (ICRT) and 266 (29%) were treated with EBRT only. The median duration of treatment for these 907 patients was 51 days. Between 1966 and 1980, only 52% of patients who completed treatment with curative intent received ICRT, compared with 92% of patients treated during 1981-1993, an increase that reflects an evolution in the philosophy of treatment for advanced tumors. In general, the intensity of ICRT correlated inversely with the dose of EBRT to the central pelvis. Median follow-up of surviving patients was 134 months.Results: For 983 patients treated with initial curative intent, disease-specific survival (DSS) was significantly worse for those who were < 40 years old, had experienced more than a 10% weight loss, or had a hemoglobin level < 10 g/dl before or during radiation therapy. Tumor factors that correlated with a relatively poor DSS were bilateral pelvic wall involvement, clinical tumor diameter greater than or equal to 8 cm, hydronephrosis, lower vaginal involvement, and evidence of lymph node metastases on lymphangiogram (p < 0.01 in all cases). For the 907 patients who completed treatment with curative intent, 641 who had ICRT had a DSS of 45% at 5 years, compared with 24% for those treated with EBRT alone (p < 0.0001). Those who received > 52 Gy of EBRT to the central pelvis had DSS rates of 27-34%, compared with 53% for patients treated with lower doses of EBRT to the central pelvis and more intensive ICRT (p < 0.0001). At 5 years, the actuarial risk of major complications was also greater for patients treated with > 52 Gy of EBRT to the central pelvis (57-68%), compared with those who had 48-52 Gy (28%) and those who had less than or equal to 47 Gy of EBRT to the central pelvis (15%) (p < 0.0001). Outcome was also compared for four time periods during which different treatment policies were in place for patients with Stage IIIB disease. The highest DSS (51%) and lowest actuarial complication rate (17%) were achieved during the most recent period (1981-1993) when modest doses of EBRT were combined with relatively intensive ICRT (p < 0.01 for both comparisons).Conclusion: Aggressive use of ICRT, carefully balanced with pelvic EBRT, is necessary to achieve the best ratio between tumor control and complications for patients with FIGO Stage IIIB carcinoma of the cervix. In our experience, the highest DSS rates and the lowest complication rates were achieved with a combination of 40-45 Gy of EBRT combined with ICRT. (C) 1999 Elsevier Science Inc.