与外阴癌治疗相关的晚期胃肠道和膀胱毒性

　　Late GI and Bladder Toxicities Associated with Treatment for Vulvar Cancer

　　J.A. Cox¹, R.A. Samper-Ternent², M.J. Wolski¹, Y.F. Kuo³, G.S. Wilkinson⁴, J.L. Freeman³, S.S. Hatch¹

　　¹Radiation Oncology, ²Sealy Center on Aging, ³Internal Medicine-Geriatrics, ⁴PMCH-Epidemiology & Biostat, University of Texas Medical Branch, Galveston, TX, USA

　　Introduction: Limited literature exists to guide practitioners on counseling women about late toxicities associated with definitive therapies for vulva cancer (VC). We looked at the impact of treatment modalities (Surgery (Sx), radiation therapy (RT), chemotherapy (CTX) or combined therapies) on the development of late GI and bladder (BL) toxicities.

　　Methods: We estimated late toxicity rates in women diagnosed with VC using SEER-Medicare data between 1992-2005 (n=3,774). Late GI and BL diagnoses were identified if occurring 6-60 months after cancer diagnosis. Cox-proportional hazard models were used to estimate risk of late GI or BL toxicity stratified by treatment modality and cancer stage.

　　Results: Percentage of late GI toxicities was lowest among patients receiving RT alone (20.5%). In contrast, Sx alone, RT alone and combined RT/CTX have the lowest BL toxicity (~30%). The highest percentage of GI and BL toxicities occur in tri-modality therapy (54.3% GI and 34.3% BL). Toxicities by cancer stage were not significantly different.

　　Unadjusted hazard ratios, compared to Sx alone, show risk of developing late GI toxicity is higher for combination therapy (Sx/RT: HR 1.55, 95% CI(1.29-1.86); RT/CTX: HR 1.65,(1.19-2.29); Sx/RT/CTX: HR 2.21, (1.65-2.95)). The risk for late BL toxicities was highest for RT alone (HR 1.92,(1.25-2.93)), followed by tri-modality (HR 1.69, (1.17-2.42)) and Sx/RT (HR 1.57,(1.26-1.96)).

　　Conclusions: Tri-modality treatment for VC is associated with higher likelihood of late GI and BL toxicities. However, RT alone resulted in the highest likelihood of late BL toxicities. Patient counseling should include discussion of late toxicities related to VC therapies.

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