补救性放化疗对宫颈癌术后盆腔复发和未控患者的治疗价值

目的探讨宫颈癌术后盆腔局部复发或未控的患者行同步放化疗的治疗效果。方法选取江苏省苏北人民医院2008年1月至2016年12月宫颈癌术后复发或未控进行补救性放化疗患者32例。从宫颈癌术后到复发的平均间隔时间是27个月。全盆腔体外放疗的剂量临床靶区剂量(CTV)50.0~50.4 Gy,肿瘤靶区(GTV)在CTV基础上局部推量10.0~15.0 Gy。在体外放疗结束后,针对残端复发患者进行阴道模后装放疗,总量15.0~30.0 Gy。32例患者均接受顺铂同步化疗,10例患者在同步放化疗后接受了顺铂联合紫杉醇的巩固化疗。采用Logistic回归模型确定治疗反应的预测因素,采用时序检验方法分析最初的国际妇产科协会(FIGO)分期、盆壁浸润、复发肿瘤大小和缓解状态与生存状态的关系。结果所有患者完成了剂量≥50.0 Gy的放疗。26例(81.2%,26/32)患者得到完全缓解。单因素Logistic回归分析表明,FIGO分期、复发肿瘤的大小及盆壁的浸润是达完全缓解的重要预测因素。5年无进展生存期、局部控制率,无远处转移生存率和总生存率分别是68.7%,78.1%,81.3%,75.0%。单变量时序检验表明,FIGO分期、盆壁浸润和完全缓解状态是影响无进展生存期和总生存率的重要因素。同步放化疗轻中度急性和晚期毒性发生率为4例(12.5%)和1例(3.1%)。维持性化疗的急性毒性发生率为40%(4/10)。结论对于局限于盆腔的复发或未控宫颈癌,积极补救行同步放化疗是可行的,具有良好的治疗效果和可接受的毒性。

Therapeutic value of salvage radiotherapy with concurrent chemotherapy for pelvic recurrence and uncontrolled disease after radical hysterectomy for cervical carcinoma

ObjectiveTo investigate the treatment outcomes of patients with pelvic recurrence or uncontrolled disease after radical hysterectomy for uterine cervical cancer who received salvage radiotherapy (RT) with concurrent chemotherapy. MethodsThirty-two patients with pelvic recurrence or uncontrolled disease after hysterectomy for uterine cervical cancer who received salvage chemoradiotherapy at Subei People's Hospital of Jiangsu Province between January 2008 and December 2016 were enrolled retrospectively. The median interval between initial operation and recurrence was 27 months. Whole-pelvic irradiation was delivered at a median dose of 50.0-50.4 Gy, followed by a boost at a median dose of 10.0-15.0 Gy to the gross tumor volume. Cisplatin-based concurrent chemotherapy was administered to all patients, and 10 patients accepted paclitaxel-cisplatin consolidation chemotherapy after chemoradiotherapy. The Logistic regression model was used to determine the predictors of treatment response, and the timing test was used to analyze the relationship between the initial International Federation of Gynecology and Obstetrics (FIGO) stage, pelvic wall infiltration, recurrent tumor size and remission status and survival status. ResultsAll patients completed ≥50.0 Gy RT. Complete response (CR) was achieved in 26 (81.2%, 26/32) patients. Initial International Federation of Gynecology and Obstetrics stage, tumor size at recurrence, and pelvic sidewall involvement were identified to be important predictors in univariate Logistic regression analysis. The 5-year progression-free survival (PFS), local control (LC), distant metastasis-free survival (DMFS), and overall survival (OS) rates were 68.7%, 78.1%, 81.3%, and 75.0%, respectively. FIGO stage, pelvic wall involvement and CR status were significant factors affecting PFS and OS rate in univariate log-rank test. The incidence of mild to moderate acute and late toxicities was 12.5% (4/32) and 3.1% (1/32), respectively. The incidence of severe acute toxicities was 40.0% (4/10). ConclusionAggressive salvage RT with concurrent chemotherapy for recurrent cervical cancer confined to the pelvis is feasible, with promising treatment outcomes and acceptable toxicities.