巨块型宫颈癌术后大分割放疗加同期化疗临床研究的初步结果

目的探索中晚期宫颈癌根治性术后大分割放疗+同期化疗的疗效及毒性。方法 2007年7月至2012年6月,50例行广泛全子宫切除+盆腔淋巴结清扫术后的巨块型Ib、IIa、IIb期宫颈癌患者纳入分析。治疗采用大分割放疗+同步化疗:放疗方案为3 Gy/次,每周5次,总剂量39 Gy;同步化疗方案为顺铂35~40 mg/m2,每周1次的同步化疗。观察5年无局部复发生存率(LRFS)、5年无瘤生存率(DFS)、5年无远处转移生存率(FDMS)、5年总生存率(OS)以及不良反应。结果 5年DFS为74.1%、5年LRFS为86.1%、5年FDMS为80.4%、5年OS为74.7%。所有病例整体治疗耐受性较好,虽然3/4级急性黏膜反应发生率为14%,但未发现严重的胃肠道事件或新的安全性问题。结论宫颈癌术后大分割同步放化疗不良反应可接受,治疗依从性好,总体疗效满意,但需随机对照试验进一步证实。

Preliminary results of a clinical study on postoperative hypofractionated high-dose radiotherapy plus concurrent chemotherapy for patients with bulky cervical cancer

Objective To explore the efficacy and toxicity of postoperative hypofractionated high-dose radiotherapy plus concurrent chemotherapy for patients with bulky Ib-, IIa-, lib-stage cervical cancer. Methods A total of 50 patients with cervical cancer in stage bulky Ib, IIa, IIb treated with routine radical hysterectomy plus pelvic lymph node dissection in the hospital were included in the analysis from July 2007 to June 2012. All the patients received standard pelvic portals to a total dose of 39 Gy in 13 fractions over 17 days （ i. e. hypofractionated high-dose radiotherapy） and concurrent chemotherapy with cisplatin at the dose of 35-40 rag/m2, weekly when irradiated. The main evaluating contents of the study were 5-year local recurrence-free survival （LRFS）, 5-year disease-free survival rate （DFS）, 5-year distant metastasis-free survival （FDMS）, 5-year overall survival （OS）, and toxicities. Results For the survival outcomes, 5-year DFS, LRFS, FDMS and OS were 74. 1%, 86. 1%, 80. 4% and 74. 7%, respectively. The hypofractionated high-dose radiotherapy was generally well-tolerated with a decent safety profile. No serious gastrointestinal events or new safety iues was observed although higher incidence of acute mucositis with 14% was found. Conclusions For patients with bulky Ib-, IIa-, lib-stage cervical cancer, the postoperative hypofractionated high-dose radiotherapy plus concurrent chemotherapy achieved acceptable toxicities, well treatment compliance and desirable overall results of efficacy. However, further investigation in a large sample-size randomized controlled trial is warranted.