目的:中危宫颈癌患者接受外照射放疗(EBRT)作为辅助治疗。通常与近距离放射治疗一起使用,而没有证实的益处。因此,我们评估了近距离放射治疗的使用频率,EBRT单独或近距离放射治疗的剂量,以及近距离放射治疗对中等风险患者的总体生存影响,早期宫颈癌.
方法:这项回顾性队列研究使用从国家癌症数据库收集的数据进行。包括2004年至2019年诊断为宫颈癌的患者,这些患者接受了根治性子宫切除术和淋巴结分期,并且疾病仅限于宫颈,但肿瘤大于4厘米或范围为2至4厘米,伴有淋巴管间隙侵犯(LVSI)。排除有远处转移或宫旁受累的患者。在2:1倾向评分匹配后,将单独接受EBRT的患者与也接受近距离放射治疗的患者进行比较。
结果:总计,1174例患者符合纳入标准,其中26.7%接受近距离放射治疗。2:1倾向评分匹配后,我们纳入了EBRT组的620例患者和联合治疗组的312例患者.接受近距离放射治疗的患者的等效剂量高于仅接受EBRT的患者。两组之间的总生存期没有差异(风险比(HR)0.88(95%置信区间(CI),0.62至1.23];p=0.45)。根据肿瘤组织学分层后,LVSI,和手术方法,近距离放射治疗与总生存率改善无关.然而,在没有同时接受化疗的患者中,接受EBRT和近距离放射治疗的患者的总生存率显着高于仅接受EBRT的患者(HR,0.48(95%CI,0.27至0.86];p=0.011)。
结论:约四分之一的研究患者接受了近距离放射治疗和EBRT。使用的剂量和放射治疗技术的可变性突出了治疗的异质性。有和没有近距离放射治疗的EBRT的总生存期没有差异。然而,接受近距离放射治疗但未同时接受化疗的患者的总生存期更长.
OBJECTIVE: Patients with intermediate-risk cervical cancer receive external beam radiotherapy (EBRT) as adjuvant treatment. It is commonly administered with brachytherapy without proven benefits. Therefore, we evaluated the frequency of brachytherapy use, the doses for EBRT administered alone or with brachytherapy, and the overall survival impact of brachytherapy in patients with intermediate-risk, early-stage cervical cancer.
METHODS: This retrospective cohort study was performed using data collected from the National Cancer Database. Patients diagnosed with cervical cancer from 2004 to 2019 who underwent a radical hysterectomy and lymph node staging and had disease limited to the cervix but with tumors larger than 4 cm or ranging from 2 to 4 cm with lymphovascular space invasion (LVSI) were included. Patients with distant metastasis or parametrial involvement were excluded. Patients who underwent EBRT alone were compared with those who also received brachytherapy after 2:1 propensity score matching.
RESULTS: In total, 1174 patients met the inclusion criteria, and 26.7% of them received brachytherapy. After 2:1 propensity score matching, we included 620 patients in the EBRT group and 312 in the combination treatment group. Patients who received brachytherapy had higher equivalent doses than those only receiving EBRT. Overall survival did not differ between the two groups (hazard ratio (HR) 0.88 (95% confidence interval (CI), 0.62 to 1.23]; p=0.45). After stratification according to tumor histology, LVSI, and surgical approach, brachytherapy was not associated with improved overall survival. However, in patients who did not receive concomitant chemotherapy, the overall survival rate for those receiving EBRT and brachytherapy was significantly higher than that for those receiving EBRT alone (HR, 0.48 (95% CI, 0.27 to 0.86]; p=0.011).
CONCLUSIONS: About one-fourth of the study patients received brachytherapy and EBRT. The variability in the doses and radiotherapy techniques used highlights treatment heterogeneity. Overall survival did not differ for EBRT with and without brachytherapy. However, overall survival was longer for patients who received brachytherapy but did not receive concomitant chemotherapy.