ⅠB～ⅡB期宫颈癌治疗相关研究进展

宫颈癌是全世界女性因癌症死亡的第4大原因,部分ⅠB期以上患者5年生存率仅为50%左右,其治疗失败的原因主要为局部肿瘤未控制或远处转移,合理的治疗对减少宫颈癌患者的复发起到重要作用。手术和放疗仍是ⅠB~ⅡB期宫颈癌的传统治疗模式,近20年来,综合治疗及个体化治疗成为宫颈癌的主要治疗方法,并取得了一定的成效。国内外妇科肿瘤医生对ⅠB~ⅡB期宫颈癌患者在治疗方面开展了新辅助化疗、术后辅助化疗、同步放化疗、三维适形调强放射治疗、三维腔内后装治疗、淋巴结取样、前哨淋巴结活检、保留神经手术等方法,最佳治疗模式目前仍存在争议。手术、放疗和(或)化疗三者合理应用可有效地改善宫颈癌ⅠB~ⅡB期患者预后和提高患者生存率,但并发症也较多。就ⅠB~ⅡB期宫颈癌治疗模式现況,包括化疗、手术、放疗及综合治疗进行综述。     

妇科恶性肿瘤的放射治疗——宫颈癌术前放射治疗

手术和放疗是子宫颈癌主要治疗手段。局部晚期即预后不良型巨块状宫颈癌及淋巴结转移是影响可手术治疗宫颈癌预后的主要因素。目前，有许多研究认为，术前放疗可以减少肿瘤局部复发，提高存活率。     

宫颈癌术后放射治疗97例分析

目的观察具有高危因素或手术范围不够的宫颈癌病人术后放疗的疗效和并发症。方法对北京妇产医院1990-01—2004—12的97例FIGOⅠA～ⅡB手术后行放疗的宫颈癌患者，计算其5年存活率，观察治疗并发症。并对我院同期ⅠA～ⅡA单独手术治疗、ⅡA单独放疗的宫颈癌患者进行统计学分析，以比较观察各组术后放疗的效果。结果97例术后放疗的患者5年存活率为71．1％，其中ⅠA期为87．5％，ⅠB期为73．7％，ⅡA期为63，6％，ⅡA期为60，0％。总的Ⅰ、Ⅱ期5年存活率分别为75．4％、62．5％。单独手术和单独放疗的病例，Ⅰ期5年存活率为87，8％，Ⅱ期为80．4％。单独手术的宫颈癌患者，ⅠA期5年存活率为97．2％，ⅠB期84．5％，ⅡA期77．8％；单独放疗的ⅡA期宫颈癌患者5年存活率为80．8％。总的单独手术和单独放疗的病例的5年存活率，Ⅰ期为87．8％，Ⅱ期为80．4％。结论具有高危因素的Ⅰ、Ⅱ期宫颈癌术后放疗疗效差，尤其在诸如手术范围不够、多个或多组淋巴结转移、脉管瘤栓、不良病理类型、癌细胞分化不良者，对于这些病例的治疗方案尚待进一步的研究。     

ⅠB2和ⅡA2期宫颈癌术前放疗联合手术与根治性放化疗的疗效和生活质量对比

目的探讨术前放疗联合手术治疗ⅠB2、ⅡA2期宫颈癌的疗效和晚期不良反应。方法 96例病理确诊的初治ⅠB2、ⅡA2期宫颈癌患者,随机分为术前放疗组和同期放化疗组,术前放疗组患者采用盆腔适形调强放疗联合腔内后装放疗,放疗后行广泛性子宫切除+盆腔淋巴结清扫术。同期放化疗组接受盆腔外照射联合后装放疗,同期顺铂化疗增敏。结果术术前放疗组及根治性放疗组患者的5年无进展生存率(PFS)分别为62.0%、45.8%(χ2=3.854,P=0.05);5年总生存率分别为70.2%、60.4%(χ2=1.987,P=0.159);远期生活质量FACT-Cx量表的五大模块得分相当,两组无明显差异。结论术前放疗联合手术延长了ⅠB2、ⅡA1期宫颈癌的无进展生存率,且长期生活质量无明显差异,是临床可行的治疗模式。     

ⅠB2和ⅡA2期宫颈癌术前放疗联合手术与根治性放化疗的疗效和生活质量对比北大核心CSCD

目的探讨术前放疗联合手术治疗ⅠB2、ⅡA2期宫颈癌的疗效和晚期不良反应。方法 96例病理确诊的初治ⅠB2、ⅡA2期宫颈癌患者,随机分为术前放疗组和同期放化疗组,术前放疗组患者采用盆腔适形调强放疗联合腔内后装放疗,放疗后行广泛性子宫切除＋盆腔淋巴结清扫术。同期放化疗组接受盆腔外照射联合后装放疗,同期顺铂化疗增敏。结果术术前放疗组及根治性放疗组患者的5年无进展生存率（PFS）分别为62.0%、45.8%（χ2=3.854,P=0.05）;5年总生存率分别为70.2%、60.4%（χ2=1.987,P=0.159）;远期生活质量FACT-Cx量表的五大模块得分相当,两组无明显差异。结论术前放疗联合手术延长了ⅠB2、ⅡA1期宫颈癌的无进展生存率,且长期生活质量无明显差异,是临床可行的治疗模式。     

放射治疗子宫颈癌580例临床分析

目的探讨外照射加腔内后装照射治疗宫颈癌的疗效及放疗并发症的治疗。方法回顾性分析1990年7月至2000年3月河南省肿瘤医院应用腔内后装放疗与体外照射相结合治疗子宫颈癌580例的临床资料。结果580例宫颈癌患者,I期2例(0.34%),Ⅱ期292例(50.34%),III期277例(47.76%),IV期9例(1.56%)。5年总的存活率为62.75%。临床Ⅱ、Ⅲ期中肿瘤直径≤4cm者5年存活率分别为73.91%及60.58%,明显高于直径>4cm患者的5年存活率40.32%及40.18%(P均<0.05)。Ⅱ、Ⅲ期治疗前血红蛋白<100g/L组的5年存活率分别为31.56%及29.60%,≥100g/L组的5年存活率分别为68.49%及68.59%,两组比较差异显著(P均<0.01)。临床II期中病理分级Ⅱ级者5年存活率为75.00%,Ⅲ级者为58.60%,两者比较差异显著(P<0.05)。放射性膀胱炎和放射性直肠炎的发生率分别为3.97%和5.0%。结论影响外照射加腔内后装照射治疗宫颈癌预后的因素是肿瘤期别、大小,治疗前血红蛋白水平及病理分级。外照射加腔内后装照射治疗宫颈癌疗效肯定,晚期并发症发生率较少。     

以直径2cm作为临界标准行保留生育功能治疗早期宫颈癌局部肿瘤疗效的Meta分析

目的:探讨Ⅰ～Ⅱ期宫颈癌局部肿瘤直径2cm行保留生育功能手术治疗的安全性。方法:计算机检索Pubmed、Medline、CBM、VIP及CNKI等数据库,收集近10年Ⅰ～Ⅱ期宫颈癌局部肿瘤大小(以2cm为界)行保留生育功能治疗的对照试验,筛选出符合纳入标准的文献,对其进行质量评价,利用RevMan5.0软件对研究结果进行Meta分析。结果:最终纳入11篇文献,共1052例患者。Meta分析结果显示,Ⅰ～Ⅱ期宫颈癌局部肿瘤直径2cm行保留生育功能治疗的复发率显著高于局部肿瘤2cm者(合并OR=0.07,95%CI为0.04～0.13,P0.00001)。结论:肿瘤直径2cm是早期宫颈癌保守治疗复发的高危因素,不建议此类患者行保留生育功能手术。若患者有强烈生育要求可行保留生育功能治疗,术后应加强随访,但不能代替传统的根治性子宫切除术(RH)和盆腔淋巴结清扫。     

早期宫颈癌的近距离放疗和阴式子宫切除

手术、放疗或手术联合放疗对早期宫颈癌局部控制率均可达到90％,治疗方式的选择依据各种方法的并发症类型和发生率以及医师的经验。虽然近距离放疗后6周手术切除可使1b期宫颈癌完全缓解率达到80％以上,但通常采用的是Piver Ⅲ型子宫根治术。为探讨近距离放疗后阴式子宫切除治疗无不良预后因素(<1.5cm)的早期宫颈癌的有效性和安全性,选择经直接测量或宫颈锥切标本病理学检测肿瘤直径<1.5cm、腹腔镜下淋巴结切除证实无淋巴结转移的早期宫颈癌22例(Ia_2期3例,Ib_1     

子宫颈癌术前辅助治疗的规范化

新辅助化疗（neoadjuvant  chemotherapy, NACT）是子宫颈癌术前或放疗前辅助治疗的主要方式,原则上适用于局部晚期（ⅠB3 ～ⅣA期）和部分特殊类型的子宫颈癌患者。顺铂为首选药物,推荐化疗2～3个疗程。肿瘤直径大于4 cm的ⅠB3～ⅡA2期的子宫颈鳞癌和腺癌的部分患者可以采用新辅助化疗+根治性手术+盆腔淋巴结切除术的治疗模式。子宫颈小细胞神经内分泌肿瘤采用新辅助化疗后行全子宫切除术,术后辅助性放疗或同期放化疗,后续再联合其他全身治疗。规范应用NACT术前辅助治疗子宫颈癌,严格把握适应证,充分发挥其疗效优势至关重要。     

不同治疗方法对Ⅰ、Ⅱ期子宫内膜癌治疗后复发、转移及并发症的影响

目的　研究不同治疗方法对Ⅰ、Ⅱ期子宫内膜癌治疗后复发、转移及并发症的影响。方法　根据不同治疗方法将 2 0 5例Ⅰ、Ⅱ期子宫内膜癌患者分为手术组、术前腔内全量放射治疗 (放疗 )组、术前腔内非全量放疗组和单纯放疗组 4组 ,对其治疗后复发、转移及并发症进行分析、比较。结果手术组、术前腔内全量放疗组、术前腔内非全量放疗组及单纯放疗组的总复发转移率分别为 19.8%、8.1%、2 2 .2 %、34 .6 % ,其中阴道残断复发率分别为 6 .2 %、1.6 %、11.1%、11.5 % ;放疗并发症中 ,放射性直肠炎、膀胱炎的发生率 ,术前腔内全量放疗组均为 3.2 % ,术前腔内非全量放疗组分别为 2 .8%、0 .0 % ,单纯放疗组分别为 0 .0 %、3.8%。结论　术前腔内全量放疗组的复发转移率最低 ,而且放疗后并发症发生率也低 ,是治疗Ⅰ、Ⅱ期子宫内膜癌较为理想的方法。     

子宫内膜癌的放射治疗

近年来，随着对子宫内膜癌生物学行为认识的不断深入及放疗技术的不断进步，放疗在子宫内膜癌治疗中发挥着越来越重要的作用，在提高疗效和降低并发症方面都取得了很大进展，但也提出了一些新的问题。     

宫颈癌术后辅助放疗

早期宫颈癌可选择手术或放疗。同时采用多种治疗手段如手术和放疗合用并不能提高患者的存活率。而且，治疗手段越多，并发症越常见。所以，若选择手术治疗，多数情况下手术后并不需要加用放射治疗。只有对有复发危险因素的患者才考虑进行辅助治疗。宫颈癌术后放疗的有效率可达66．0％，目前被广泛应用于具有高危因素的患者。     

子宫颈癌放射治疗的规范化

子宫颈癌是影响中国女性健康的重大疾病。随着对该疾病认识的加深,以手术、放疗、化疗相结合的综合治疗模式日趋成熟。文章根据子宫颈癌发展的不同阶段,系统阐述了放射治疗在子宫颈癌治疗中的应用和价值,以期为临床决策提供参考。     

Preoperative radiotherapy for early endometrial carcinoma

A retrospective study was undertaken to compare the use of one versus two preoperative radium systems for early endometrial carcinoma. The charts of 73 patients treated between 1977 and 1980 were reviewed. No difference was noted between the two groups when compared for stage, grade, depth of myometrial invasion, and histologic type of tumor. One of thirty-eight (2.6%) patients in the one-radium group developed an isolated central recurrence; there were no central recurrences in the two-radium group. Total duration of therapy and total hospitalization for the one-radium versus the two-radium group were 17.6 and 15.3 days versus 77.0 and 17.3 days, respectively. Follow-up ranged from 48 to 84 months. Corrected survival figures are comparable to 94.6% for the one-radium group versus 100% for the two-radium group. These data suggest comparable effectiveness and morbidity between the two treatment regimens, with the single-radium application more efficient and cost effective.     

Referral patterns for gynaecological radiotherapy in Victoria

A retrospective chart review was undertaken on all patients in Victoria who were referred for radiotherapy for a gynaecological cancer from February 1997 to January, 1998. Three hundred and ten patients were identified which represents less than one-third of all gynaecological cancers diagnosed in Victoria each year. Ninety-two of the 310 patients (30%) referred for radiotherapy were managed without the prior involvement of a certified gynaecological oncologist. The 310 patients included 95 patients with cervical cancer, 33 patients with ovarian cancer and 142 patients with endometrial cancer. The initial management strategies employed for patients with the major gynaecological cancers varied depending on the source of referral. This difference was most marked in endometrial cancer due mainly to differing indications for full surgical staging and subsequent referral for radiotherapy both between types of specialists and also between gynaecological oncology units. The development of evidence based guidelines in the major gynaecological cancers should lead to a more uniform approach to the care of women with gynaecological malignancies.     

Groin angiosarcoma following radiotherapy for vulvar cancer

BACKGROUND: Angiosarcomas account for less than 2% of all sarcomas. However, they represent 15% of radiotherapy-induced sarcomas, usually associated to the treatment for breast cancer, cervical cancer, and lymphomas. CASE REPORT: We report the case of a 56-year-old patient who developed a soft tissue angiosarcoma in the right groin 25 years after receiving radiotherapy for vulvar cancer. To our knowledge, this is the second case reported of a soft tissue angiosarcoma after radiotherapy for a vulvar cancer. CONCLUSION: Postradiation sarcoma must be considered in patients with a history of a previous tumor when a soft tissue mass is seen in the previously irradiated field, especially if the latent period is more than 3 or 5 years. The correct histologic interpretation of such lesions is important because it may result in early identification of the secondary malignancy and may contribute to better management and improved prognosis.     

Radical hysterectomy with adjuvant radiotherapy versus definitive radiotherapy alone for FIGO stage IIB cervical cancer

Objectives

The aim of this study was to compare the treatment outcomes and adverse effects of radical hysterectomy followed by adjuvant radiotherapy with definitive radiotherapy alone in patients with FIGO stage IIB cervical cancer.

Methods

We retrospectively reviewed the medical records of FIGO stage IIB cervical cancer patients who were treated between April 1996 and December 2009. During the study period, 95 patients were treated with radical hysterectomy, all of which received adjuvant radiotherapy (surgery-based group). In addition, 94 patients received definitive radiotherapy alone (RT-based group). The recurrence rate, progression-free survival (PFS), overall survival (OS), and treatment-related complications were compared between the two groups.

Results

Radical hysterectomy followed by adjuvant radiotherapy resulted in comparable recurrence (44.2% versus 41.5%, p = 0.77), PFS (log-rank, p = 0.57), and OS rates (log-rank, p = 0.41) to definitive radiotherapy alone. The frequencies of acute grade 3–4 toxicities were similar between the two groups (24.2% versus 24.5%, p = 1.0), whereas the frequencies of grade 3–4 late toxicities were significantly higher in the surgery-based group than in the RT-based group (24.1% versus 10.6%, p = 0.048). Cox multivariate analyses demonstrated that treatment with surgery followed by adjuvant radiotherapy was associated with an increased risk of grade 3–4 late toxicities, although the statistical significance of the difference was marginal (odds ratio 2.41, 95%CI 0.97–5.99, p = 0.059).

Conclusions

Definitive radiotherapy was found to be a safer approach than radical hysterectomy followed by postoperative radiotherapy with less treatment-related complications and comparable survival outcomes in patients with FIGO stage IIB cervical cancer.     

Concurrent chemotherapy and radiotherapy for cervical cancer

OBJECTIVE: To compare the results obtained following treatment, from a group of patients with locally advanced cervical cancer (Stage IB or higher) treated with concurrent chemotherapy and radiotherapy in relation to a group of patients treated exclusively with radiotherapy. MATERIAL AND METHOD: All patients treated with concurrent chemotherapy and radiotherapy at the Gynaecologic Oncology Unit of the University Hospital Materno Infantil of the Canaries between 1999 and 2000, both inclusive, were included. The first group to be considered was formed by patients who received combined treatment. The second group of patients received radiotherapy exclusively, having been treated in previous years (1997-1998 period). The results were compared in relation to survival in the two following years from treatment (2000-2001) in the group of combined treatment and years 1999-2000 in the group that received only radiotherapy. To compare the survival of both groups the chi-square test and Odds Ratio were utilised. RESULTS: The groups compared are homogeneous when looking at the stage of the disease when diagnosed, the histological type of tumour and its degree of cellular differentiation, the CAT results and tumoral markers. Survival of more than two years was observed in the group treated with concurrent chemotherapy and radiotherapy in relation to the group treated exclusively with radiotherapy; chi-square 9.92, p < 0.01, OR: 0.1 (0.01-0.6).     

Pregnancy outcome following radiotherapy for naso-pharyngeal carcinoma

Nasopharyngeal carcinoma complicating pregnancy is uncommon, and its treatment with irradiation is problematical, as the irradiation risks in pregnancy have not been well defined. In this paper, we described a pregnant patient with nasopharyngeal carcinoma who received irradiation treatment during the pregnancy. The management and the risk of irradiation are discussed.     

Results of radical radiotherapy for recurrent endometrial cancer

OBJECTIVES: The aims of this study were to determine the overall survival (OS) and local control (LC) achieved in patients developing a locoregional recurrence of endometrial carcinoma and to define those prognostic factors that predict for improved LC and OS. METHODS: Between 1984 and 1988, 958 women were referred to Princess Margaret Hospital (PMH) with a diagnosis of endometrial carcinoma. Of these, 58 were treated for recurrent disease with radical radiotherapy (RT). Forty-two were referred with recurrence and 16 relapsed during follow-up at PMH for their primary tumor. None had received prior RT. The majority (n = 49) were treated with combined external beam RT followed by an intracavitary cesium insertion. RESULTS: The median time to relapse from original diagnosis was 1.3 years (range 0.2-13.4 years). The actuarial 5- and 10-year OS was 53 and 41%, respectively. The respective results for LC were 65 and 62%. All end-points were measured from the time of relapse. The median total dose received was 81.5 Gy. Univariate analysis showed that favorable histological features at original diagnosis (<50% myometrial involvement, grade 1-2, P = 0.007) and Perez modified staging (P = 0.02) were significant predictors for OS. The Perez staging (P = 0.02) and size of recurrence (<2 cm versus >/=2 cm, P = 0.04) were predictors for LC. CONCLUSION: Patients with localized relapse of endometrial carcinoma in whom radical radiotherapy can be administered should be treated aggressively and may be cured in over half the cases treated. Pathological findings in the original surgical specimen, size of recurrent disease, and a modified vaginal carcinoma staging system are significant predictors of local pelvic control and survival.