摘要
目的 研究老年宫颈癌患者在根治性放疗基础上联合化疗的疗效和安全性、放化疗时序对预后的影响.方法 回顾性分析2018年1月至2022年7月在苏州大学附属第一医院放疗科接受根治性放疗的112例65～80岁宫颈癌患者的治疗,并继续随访至2023年1月31日.26例患者仅接受了根治性放疗(单纯放疗组),86例患者接受了根治性放疗联合化疗(放化疗组),其中序贯放化疗组57例、同步放化疗组29例.采用卡方检验、Fisher确切概率法、单因素方差分析、配对样本t检验及Kruskal-Wallis检验,分析比较放化疗组与单纯放疗组、序贯放化疗组和同步放化疗组以及≥70岁高龄患者层的各组的近期疗效、客观缓解率(ORR)、疾病控制率(DCR)、无进展生存(PFS)期、总生存(OS)期及不良反应情况.结果 放化疗组与单纯放疗组患者的近期疗效、ORR、DCR的差异均没有统计学意义(P=0.245、0.715、0.551);中位PFS期为25个月比19个月(P=0.265),中位OS期为53个月比30个月(P=0.040);两组最常见的3～4级不良反应均是淋巴细胞减少,两组的血液学及胃肠道不良反应发生率的差异有统计学意义(均为P＜0.05).序贯放化疗组与同步放化疗组患者的近期疗效、ORR、DCR、中位PFS、中位OS差异均无统计学意义(均为P＞0.05),但同步放化疗组的胃肠道不良反应发生率明显高于序贯放化疗组(P=0.024).≥70岁高龄患者中,各组比较的结果和全组放化疗组与单纯放疗组比较的结果基本一致.结论 在根治性放疗基础上联合化疗是老年宫颈癌患者,甚至是≥70岁高龄患者有效且相对安全的治疗方式,序贯放化疗与同步放化疗在老年患者中疗效相当,但前者的胃肠道反应发生率明显减低.
Abstract
Objective To investigate the efficacy and safety of combined chemotherapy based on radical radiotherapy in elderly patients with cervical cancer,as well as the influence of the sequence of radiotherapy and chemotherapy on clinical prognosis.Methods Clinical data of 112 elderly patients with cervical cancer aged 65-80 years who received radical radiotherapy in Department of Radiotherapy Oncology of the First Affiliated Hospital of Soochow University from January 2018 to July 2022 were retrospectively analyzed.The follow-up deadline was January 31,2023.A total of 26 patients received radical radiotherapy alone(radiotherapy alone group),while 86 patients received radical radiotherapy combined with chemotherapy(chemoradiotherapy group),including sequential chemoradiotherapy group(n=57)and concurrent chemoradiotherapy group(n=29).The recent efficacy,objective response rate(ORR),disease control rate(DCR),progression-free survival(PFS),overall survival(OS),and incidence of adverse reactions in patients between the chemoradiotherapy group and radiotherapy alone group,sequential chemoradiotherapy group and concurrent chemoradiotherapy group,elderly patients aged ≥70 years old were analyzed by Chi-square test,Fisher exact probability method,one-way ANOVA,paired sample t-test and Kruskal-Wallis test.Results There were no significant differences in recent efficacy,ORR and DCR between chemoradiotherapy group and radiotherapy alone group(P=0.245,0.715 and 0.551).The median PFS was 25 months vs.19 months(P=0.265),and the median OS was 53 months vs.30 months(P=0.040).Lymphocytopenia was the most common grade 3-4 adverse reactions between two groups,and there were statistically significant differences in hematological adverse reactions and gastrointestinal adverse reactions between two groups(both P＜0.05).There were no significant differences in recent efficacy,ORR,DCR,median PFS and median OS between sequential chemoradiotherapy group and concurrent chemoradiotherapy group(all P＞0.05).However,the gastrointestinal adverse reactions in the concurrent chemoradiotherapy group were significantly higher than those in the sequential chemoradiotherapy group(P=0.024).The results of elderly patients aged ≥70 years old were basically consistent with those between the chemoradiotherapy group and radiotherapy alone group.Conclusions Combined chemotherapy based on radical radiotherapy is an effective and relatively safe treatment for elderly patients even those aged ≥70 years old with cervical cancer.Sequential and concurrent chemoradiotherapy have similar therapeutic effects in elderly patients,but the incidence of gastrointestinal reactions is significantly reduced in the former.
维普
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