Post-operative radiotherapy in patients with early stage cervical cancer
Post-operative radiotherapy in patients with early stage cervical cancer
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DOI：
10.1016/j.ygyno.2014.04.045
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发表时间：
2014-07-01
影响因子：
4.7
通讯作者：
Stalpers, Lukas J. A.
中科院分区：
文献类型：
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作者：
Fajardo, Raquel Davila;van Os, Rob;Stalpers, Lukas J. A.
Objective.本研究的目的是调查宫颈癌患者辅助（化疗）放疗治疗政策的变化的影响。1970年至2007年，292例早期宫颈癌患者在根治性子宫切除术和盆腔淋巴结清扫术后接受辅助放疗。所有患者均接受盆腔放射治疗（40戈伊~ 46戈伊，1.8戈伊~ 2戈伊/次）。阴道穹窿近距离放射治疗加强（10-14戈伊）越来越多地用于具有高危因素的患者，自1993年以来，系统地应用于具有3种风险因素中至少2种的患者：腺癌、淋巴结受累和宫旁浸润。自2000年开始对这组患者采用以顺铂为基础的化疗。5年累积局部复发风险（CRLR）为13%（95%CI 9%-17%），导致5年总生存率（OS）为78%（95%CI 83%-73%）。自1970年以来，5年局部复发风险（LRR）的OR从2.5降至1.15（线性OR = -0.02/年）。5年死亡风险的OR从1970年的2.2降低到2007年的1.0（线性OR = -0.03/年）。1990年之前风险降低幅度最大，2002年之后略有上升。重度晚期毒性的风险从1.8%降至1.5%（线性OR = -0.03/年）。自2000年以来，辅助化疗的增加可能使鳞状细胞癌患者亚组获益，但腺癌患者并非如此，化疗后严重晚期毒性的风险增加了两倍，从2%增加到7%。自1970年以来，随着辐射剂量的增加，肿瘤复发风险和死亡率有所下降。在这项非随机研究中，无法证明伴随辅助化疗的潜在获益。(C)2014爱思唯尔公司All rights reserved.
Objective. The aim of this study is to investigate the impact of treatment policy changes in cervical cancer patients treated with adjuvant (chemo) radiotherapy.Methods. Between 1970 and 2007, 292 patients received adjuvant radiotherapy after a radical hysterectomy with pelvic lymphadenectomy for early stage cervical carcinoma. All patients received pelvic radiotherapy (40 Gy-46 Gy in 1.8 Gy-2 Gy/fraction). Vaginal vault brachytherapy boost (10-14 Gy) was increasingly used for patients with high-risk factors, and since 1993 systematically applied in patients with at least 2 of the 3 risk factors: adenocarcinoma, nodal involvement and parametrial invasion. Cisplatin-based chemotherapy was introduced in this group of patients from 2000.Results. The 5-year cumulative risk of local recurrence (CRLR) was 13% (95%CI 9%-17%), resulting in an overall 5-year survival (OS) of 78% (95%CI 83%-73%). Since 1970, the OR for the 5-year locoregional recurrence risk (LRR) decreased from 2.5 to 1.15 (linear-OR = -0.02/year). The OR for the 5-year mortality risk reduced from 2.2 in 1970 to 1.0 in 2007 (linear-OR = -0.03/year). The largest risk reductions were observed before 1990 with a minor rise after 2002. The risk of severe late toxicity reduced from 1.8% to 1.5% (linear-OR = -0.03/year). The addition of concomitant adjuvant chemotherapy since 2000 may have benefited a subgroup of patients with squamous cell carcinoma, but not the patients with adenocarcinoma, and after introduction of chemotherapy the risk of severe late toxicity tripled from 2% to 7%.Conclusion. Since 1970, tumour recurrence risk and mortality have decreased, as radiation dose increased. The potential benefit of concomitant adjuvant chemotherapy could not be demonstrated in this nonrandomized study. (C) 2014 Elsevier Inc. All rights reserved.