早期高危宫颈癌术后IMRT同期或序贯化疗临床研究

目的 评价早期高危宫颈癌患者术后IMRT同期化疗或序贯化疗疗效和急性不良反应。方法 回顾分析2009—2017年收治的105例早期(ⅠB1-ⅡA2)高危宫颈癌术后患者临床资料,将患者分为IMRT同期化疗(C-IMRCT)组73例和IMRT序贯化疗(S-IMRCT)组32例。比较两组5年DFS、OS率及复发率、转移率和急性不良反应。采用Kaplan-Meier法计算生存率并Logrank检验和单因素预后分析,复发、转移、不良反应比较采用连续性校正χ²检验。结果 C-IMRCT、S-IMRCT组中位随访时间分别为20、23个月(P=0.813)。C-IMRCT、S-IMRCT组5年DFS分别为72.6%、72.5%(P=0.918),OS分别为82.8%、78.5%(P=0.504)。两组复发、转移情况均相近(P=0.598、1.000)。单因素预后分析未显示病理因素影响患者预后。急性不良反应主要为1、2级急性血液学毒性且两组总发生率相近(46.6%∶41.9%,P=0.884),胃肠道反应(腹泻)、尿路感染均相近(P=0.854、0.271)。结论 IMRT同期化疗治疗早期高危宫颈癌术后患者的生存率值得临床进一步研究。

A comparative clinical study of postoperative intensity-modulated radiotherapy combined with concurrent and sequential chemotherapy for high-risk early-stage cervical cancer

Objective To evaluate the efficacy and acute toxicities of postoperative intensity-modulated radiotherapy (IMRT) combined with concurrent (C-IMRCT) or sequential chemotherapy (S-IMRCT) in the treatment of high-risk early-stage cervical cancer. Methods A retrospective study was performed on the clinical data of 105 patients with high-risk early-stage (ⅠB1-ⅡA2) cervical cancer from 2009 to 2017. Those patients were divided into C-IMRCT group (n=73) and S-IMRCT group (n=32). The 5-year disease-free survival (DFS) and overall survival (OS) rates, recurrence rate, metastasis rate, and acute toxicities were compared between the two groups. The survival rates were calculated by the Kaplan-Meier method and analyzed by the log-rank test. Univariate prognostic analysis was performed by the log-rank test. Recurrence, metastasis, and adverse reactions were compared using continuous correction chi-square test. Results The median follow-up time was 20 and 23 months in the C-IMRCT group and the S-IMRCT group, respectively (P=0.813). There were no significant differences in the 5-year DFS and OS rates between the two groups (72.6% vs. 72.5%, P=0.918;82.8% vs. 78.5%, P=0.504). There were no significant differences in the recurrence and metastasis rates between the two groups (P=0.598;P=1.000). The univariate prognostic analysis showed that no pathological factor affected prognosis. There were no significant differences in the incidence rates of grade 1-2 hematological toxicity, diarrhea, and urinary tract infection between the two groups (46.6% vs. 41.9%, P=0.884;P=0.854;P=0.271). Conclusions Further clinical studies are needed in terms of the survival rate in patients with high-risk early-stage cervical cancer receiving C-IMRCT.