국립암센터 / 윤상희, 김주영*
Abstract
Objective: The aim of this study was to compare the clinical outcomes of chemoradiotherapy with or without bevacizumab in patients with newly diagnosed International Federation of Gynecology and Obstetrics (FIGO) stage IVB cervical cancer.
Methods: 41 patients with stage IVB cervical cancer who underwent chemoradiotherapy between August 2015 and December 2017 were retrospectively analyzed. This study included 11 patients who received bevacizumab before or after radiotherapy (group A) and 30 patients who received conventional chemoradiotherapy without bevacizumab (group B). We excluded the following patients: those with dual primary cancers; those whose pathologic diagnosis was neither squamous cell carcinoma nor adenocarcinoma; those who did not undergo radiotherapy; or those from whom follow-up data could not be collected. We analyzed the treatment responses, toxicities, progression-free survival, and overall survival rates.
Results: A total of 41 patients were included in the analysis. The median follow-up was 19 months (range 3-108). The response rates at 3 months after treatment were 90.9% in group A and 83.3% in group B (p=0.54). After completing all treatments, the complete response rates were 81.8% in group A and 47% in group B (p=0.04). Grade ≥3 gastrointestinal toxicities, including bleeding, fistula, perforation, and obstruction, were more frequent in group A (54.5%) than in group B (6.7%) (p=0.003). The 12 month progression-free survival and overall survival rates were similar in both arms (12 month progression-free survival: 45.5% vs 46.7%, respectively, p=0.22; 12 month overall survival: 81.8% vs 72.9%, respectively, p=0.57). Patients with node-only metastasis had better 12 month progression-free survival in group B than in group A (59.1% vs 42.9%, respectively, p=0.04). However, the responses to both treatments did not differ in patients with organ metastasis.
Conclusions: Bevacizumab for stage IVB cervical cancer is associated with higher complete response rates. However, patients treated with bevacizumab experienced more bowel toxicities. Bevacizumab did not improve progression-free survival among patients with node-only metastasis.
Affiliations
Sang Hee Youn 1 , Yeon-Joo Kim 1 , Sang-Soo Seo 2 , Sokbom Kang 2 , Myong Cheol Lim 2 , Ha Kyun Chang 2 , Sang-Yoon Park 2 , Joo-Young Kim 3
1 Proton Therapy Center, National Cancer Center, Goyang-si, Gyeonggi-do, the Republic of Korea.
2 Center for Uterine Cancer, National Cancer Center, Goyang-si, Gyeonggi-do, the Republic of Korea.
3 Proton Therapy Center, National Cancer Center, Goyang-si, Gyeonggi-do, the Republic of Korea jooyoungcasa@ncc.re.kr.
편집위원
Bevacizumab과 방사선치료의 병용시 GI toxicity가 증가할 수 있지만 확정적이지 않은 상태에서 stage IVB cervix cancer에서 category1으로 권고되는 bevacizumab를 포함한 CTx 후 방사선치료가 의뢰되는 경우에 효과적이지만 Gr3 이상의 severe GI toxicity도 통계적으로 유의하게 증가되는 것을 보여줌으로써 임상에서 방사선치료 적용시 주의가 필요한 근거 연구입니다.
2020-07-31 15:03:47