碳离子放射治疗子宫颈腺癌：2016-2020年日本多中心前瞻性注册研究的临床结果
Carbon-Ion Radiation Therapy for Adenocarcinoma of the Uterine Cervix: Clinical Outcomes of a Multicenter Prospective Registry-Based Study in Japan (2016-2020)
DOI 原文链接
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影响因子:6.5
分区:医学1区 Top / 肿瘤学2区 核医学2区
发表日期:2025 Mar 01
作者:
Kazutoshi Murata, Noriyuki Okonogi, Ken Ando, Keisuke Tsuchida, Kaori Fukunishi, Daisuke Irie, Yoshiaki Ohyama, Masaru Wakatsuki, Munetaka Takekuma, Shingo Kato, Tatsuya Ohno
DOI:
10.1016/j.ijrobp.2024.10.003
摘要
子宫颈腺癌（AUC）患者的预后通常较鳞状细胞癌差。关于AUC的碳离子放射治疗（CIRT）疗效，多为回顾性或单一机构的前瞻性研究，尚缺乏多中心前瞻性研究。本研究报告在日本全国医院注册的基础上，进行的多中心前瞻性CIRT治疗AUC的结果。纳入对象为2016年6月至2020年4月期间在4个日本中心接受CIRT治疗的局部晚期未治疗AUC患者。无器官功能障碍者可接受最多5次每周40 mg/m2的顺铂化疗。主要终点为2年总生存率和局部控制率。次要终点包括2年无病生存率和晚期不良事件（AEs）。共入组42例患者，年龄中位数54岁（范围34-76岁）。患者诊断为IIB（n=26）、IIIB（n=12）或IVA（n=4）期。中位随访时间为24个月。2年总生存率为97.5%（95% CI，92.7%-100.0%），局部控制率为80.9%（95% CI，66.9%-94.8%），无病生存率为64.3%（48.1%-80.4%）。两名患者出现3级直肠/乙状结肠AEs，一名患者在局部肿瘤复发的救援手术中需要尿道造瘘，发生3级泌尿系统AEs。未报告其他3级或更严重的毒性。CIRT是治疗局部晚期AUC的有效手段，仍需进一步研究验证其安全性与有效性。
Abstract
Cases of adenocarcinoma of the uterine cervix (AUC) have poorer prognoses than those of squamous cell carcinoma. Carbon-ion radiation therapy (CIRT) outcomes for AUC have been reported in retrospective or single-institutional prospective studies but not prospective multicenter studies. We present the results of CIRT for AUC in a prospective multicenter study using a nationwide hospital-based registry in Japan.Patients with locally advanced untreated AUC who received CIRT at 4 Japanese centers between June 2016 and April 2020 were included in this study. In the absence of organ dysfunction, up to 5 weekly 40 mg/m2 cisplatin courses were administered. The primary endpoints were 2-year overall survival and local control rates. The secondary endpoints were 2-year disease-free survival rate and late adverse events (AEs).Forty-two patients were enrolled with a median age of 54 years (range, 34-76 years). Patients were diagnosed with stage IIB (n = 26), IIIB (n = 12), or IVA (n = 4) disease. The median follow-up period was 24 months. The 2-year overall survival, local control, and disease-free survival rates were 97.5% (95% CI, 92.7%-100.0%), 80.9% (95% CI, 66.9%-94.8%), and 64.3% (48.1%-80.4%), respectively. Two patients developed grade 3 rectum/sigmoid AE. One patient required urinary diversion surgery during a salvage operation for local tumor recurrence (grade 3 genitourinary AE). No other grade 3 or worse toxicities were reported.CIRT is an effective treatment for locally advanced AUC. Further research is required to validate the safety and efficacy of CIRT for AUC.