同步放化疗对早期低危宫颈鳞癌术后生存无优势

摘要

Objective:The benefits of postoperative adjuvant therapy method for low-risk early-stage cervical squamous cell carcinoma were investigated. Methods:A total of 133 patients with low-risk early-stage cervical squamous cell carcinoma were treated at Shandong Cancer Hospital&Institute from February 2008 to March 2012. All patients received adjuvant therapy:42 were treated with pelvic ra-diotherapy (RT), 47 were treated with adjuvant chemotherapy (CT)+intracavitary radiotherapy (ICRT), and 44 were treated with concurrent chemoradiation (CCRT). Disease-free survival (DFS) and complications of the therapy were evaluated. Results:No significant differences in DFS were observed in the patients treated with RT, CT+ICRT, and CCRT (P>0.05), and the three-year DFS rates were 94.0%, 93.4%, and 97.6%, respectively. The frequencies of grade III to IV acute toxicities were significantly higher in patients treated with CCRT (34.1%) than in those treated with RT (9.5%) or CT+ICRT (16.7%) (P<0.05). No statistically significant difference was observed between the RT group and the CT+ICRT group (P>0.05). Grade I to II late toxicity was significantly more frequent in the CCRT (25%) and RT (19.0%) groups compared with the CT+ICRT group (4.3%) (P>0.05), but no statistically significant differences were observed between the CCRT and the RT groups (P>0.05). Conclusion:CT+ICRT or RT has a three-year DFS rate equivalent to CCRT but with fewer therapy com-plications for low-risk early-stage cervical squamous cell carcinoma.%目的：探讨早期宫颈鳞癌术后伴有低危复发因素患者减少不良反应的最佳处理方式。方法：选取2008年2月至2012年3月山东省肿瘤医院共收治经术后病理证实，伴有1～2个低危不良预后因素的早期宫颈鳞癌患者133例。根据术后治疗方式不同分为单纯放疗组（42例）、化疗+后装治疗组（47例）和同步放化疗组（44例），比较3组患者的无疾病生存率和治疗相关并发症发生率。结果：随访时间为6～55个月，中位随访时间30个月。单纯放疗组、化疗+后装治疗组和同步放化疗组3年无疾病生存率分别为94.0％、93.4％和97.6％，差异无统计学意义（P>0.05）。3组急性重度不良反应（Ⅲ～Ⅳ级）发生率分别为9.5％、16.7％和34.1％，同步放化疗组Ⅲ～Ⅳ级不良反应发生率显著高于单纯放疗组和化疗+后装治疗组（P<0.05），而单纯放疗组与化疗+后装治疗组之间差异无统计学意义（P>0.05）。3组Ⅰ～Ⅱ度慢性放射性反应发生率分别为19.0％、4.3％和25.0％，单纯放疗组和同步放化疗组显著高于化疗+后装治疗组（P<0.05），单纯放疗组与同步放化疗组比较差异无统计学意义（P>0.05）。结论：对于早期低危宫颈鳞癌患者，与同步放化疗相比，术后采用化疗+后装治疗或单纯放疗均能够取得理想的治疗效果，而治疗相关并发症发生率明显降低。