同步化放疗时代局部晚期宫颈癌治疗时长的影响

同步化放疗时代局部晚期宫颈癌治疗时长的影响

The effect of treatment time in locally advanced cervical cancer in the era
of concurrent chemoradiotherapy.
Abstract
BACKGROUND:
This study sought to determine if treatment time impacts pelvic failure
(PF), distant failure (DF), or disease-specific mortality (DSM) in patients
undergoing concurrent chemoradiotherapy (CCRT).

METHODS: A retrospective review was performed of 113
consecutive eligible patients with stage IB2 to IIIB cervical cancer. All
patients received whole-pelvis radiation with concurrent chemotherapy and
consolidative intracavitary brachytherapy (BT) to the cervix, followed by an
external beam parametrial boost when appropriate. The effect of treatment time
on PF, DF, and DSM was examined with univariate and multivariate analyses.
Characteristics of patients with and without treatment prolongation were
compared to explore reasons for treatment prolongation.

RESULTS: The median time to completion of BT was 60 days,
and the median time to complete all RT was 68 days. The 3-year cumulative
incidence of PF, DF, and DSM were 18%, 23%, and 26%, respectively. On
multivariate analysis, time to completion of BT >56 days was associated with
increased PF (hazard ratio, 3.8; 95% confidence interval, 1.2-16; P = .02). The
3-year PF for >56 days versus ≤56 days was 26% versus 9% (P = .04). Treatment
time was not associated with DF or DSM. Treatment prolongation was found to be
associated with delay in starting BT and higher incidence of acute grade 3/4
toxicities.

CONCLUSIONS: In the setting of CCRT, treatment time >56
days is detrimental to pelvic control but is not associated with an increase in
DF or DSM. To maximize pelvic control, we recommend completing BT in 8 weeks or
less.

原文链接：http://www.ncbi.nlm.nih.gov/pubmed/22806897