年轻宫颈癌患者治疗中的过度与不足

近年来宫颈癌发病呈年轻化趋势。以手术和放疗为主的综合治疗对年轻宫颈癌患者生活质量及生理功能产生的影响远较其他年龄宫颈癌更大。因而应特别注意避免对年轻宫颈癌患者在诊断、治疗方式、术后辅助治疗等几方面存在的过度与不足。     

年轻女性宫颈癌患者保留生育功能手术进展

近年来,年轻女性（年龄小于35岁）宫颈癌的发病率呈逐年上升趋势,而目前肿瘤治疗原则是在延长生存期的同时不断提高患者的生存质量,因此对年轻的宫颈癌患者而言,生存质量成为其选择治疗方式的重要影响因素,尤其是对有生育要求的年轻女性。所以宫颈癌患者保留生育功能手术日益成为医学界新的研究热点。现对近年来年轻女性患宫颈癌的病因、病理类型、临床特点及保留生育功能手术的研究进展进行综述,以期为临床医生对年轻宫颈癌患者的预防、诊断、治疗及预后评估提供依据。     

子宫颈癌化疗的研究进展

宫颈癌居女性生殖道恶性肿瘤发病率的首位。宫颈癌化疗主要用于晚期复发转移的患者 ,近年也用化疗作为手术或放疗的辅助治疗 ,用以防治肿瘤的复发和转移。宫颈癌的综合治疗逐渐成为研究热点和治疗趋势 ,它将现有的治疗手段 ,如手术、放疗、化疗、生物治疗等取长补短 ,有机结合 ,提高了治愈率 ,延长了生存期 ,改善了生活质量     

宫颈癌化疗策略及进展

随着治疗手段的不断发展,宫颈癌的治疗效果较前明显提高。目前宫颈癌的治疗仍采用手术和放疗为主、化疗为辅的综合治疗方案。对于年轻的宫颈癌患者,放疗会损伤卵巢功能,可能导致一系列更年期症状,并且还会导致一系列并发症,严重影响患者生活质量。宫颈癌的化学治疗尤其是手术前后的辅助化疗越来越受到重视。因此,文章就宫颈癌术后辅助化疗以及术前新辅助化疗的最新进展及治疗策略做一大致总结。     

宫颈癌腹腔镜精准解剖性广泛子宫切除术

宫颈癌是最常见的女性生殖器官恶性肿瘤,经腹广泛性子宫切除加盆腔淋巴结切除术一直是治疗早期宫颈癌的标准术式.迄今的研究结果显示,早期宫颈癌手术治疗,不但可以减少患者的死亡率及肿瘤复发的机会,也可显著提高患者术后的生活质量,特别是与单纯根治性放疗比较时,在晚期并发症方面优势更为明显.     

宫颈癌治疗后性生活质量分析

目的 调查宫颈癌患者治疗后性生活质量变化及影响因素.方法 采用女性性功能指标量表(female sexual function index,FSFI)对2001年1月至2007年7月间北京妇产医院110饲宫颈癌患者性生活质量进行评分,分析年龄、文化程度、临床分期、治疗方式、治疗结束时间对宫颈癌患者性生活质量的影响.结果 年龄、文化程度、临床分期、治疗结束时间是影响宫颈癌患者性生活质量的因素,放疗及手术范围影响宫颈癌患者性生活质量.结论 宫颈癌患者性生活质量受多因素影响,应选择规范的治疗方式,对宫颈癌患者进行心理咨询、生活指导及辅助治疗,改善患者治疗后性生活质量.     

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。     

宫颈癌SNSRH手术治疗新进展

宫颈癌是女性最常见的恶性肿瘤之一。目前对于宫颈癌的治疗仍以手术治疗为主。传统手术因其创伤大,术后常因损伤盆腔自主神经所致患者近期及远期生活质量均明显下降。保留盆腔自主神经的广泛性子宫切除术,能最大限度地减少盆腔自主神经的损伤,在保证治愈疾病的同时提高患者生存质量,已成为宫颈癌手术治疗的发展趋势。     

宫颈癌动脉化疗进展

宫颈癌为常见的妇科恶性肿瘤之一,其主要治疗手段为手术和放疗,传统中人们一直认为宫颈癌对化疗不敏感,已习惯仅将化疗用于晚期与复发患者的姑息治疗。但随着肿瘤化学治疗的基础与临床研究的迅速发展,化疗药物的不断开发及给药途径和方法的改进,化疗对宫颈癌取得了一定疗效,宫颈癌的化学药物治疗越来越受到国内外学者的重视。尤其是近年来,宫颈癌的发病年龄趋于年轻化,35岁以下的患者逐渐增多,年轻患者对保留卵巢与性功能的要求也较高,本着以人为本,在不影响疗效的前提下,尽量提高患者生活质量的治疗理念,传统常用的破坏卵巢功能的术前放疗,…     

宫颈癌术前近距离放射治疗的研究进展

近距离放射治疗是宫颈癌重要的治疗手段。ⅠB~ⅡA期宫颈癌患者术前行近距离放射治疗可改善肿瘤病理分期,提高手术标本切缘阴性率,改善患者生活质量及生存预后。近距离放射治疗已从传统低剂量率向现代高剂量率、脉冲剂量率放疗发展;从二维到三维影像引导下技术发展,进一步提高了术前近距离放射治疗的有效性、精确性和安全性。本文旨在综述宫颈癌术前近距离放射治疗的相关研究进展。     

宫颈癌靶向治疗的研究进展

近年来,宫颈癌的发病率较前明显增高,并逐渐呈年轻化趋势,虽然手术、放疗、化疗等治疗方式的改进已延长患者的生存时间,改善患者的生存质量,但临床上对于晚期和复发型宫颈癌的治疗仍较为棘手,研究者们也一直在探索新的治疗方法。随着分子生物学和基因组学的研究发展,靶向治疗研究已经取得了突破性的进展,靶向治疗是在细胞分子水平上针对已明确的致癌位点设计相应的治疗药物,可特异性结合致癌位点使肿瘤细胞死亡,从而达到提高疗效、减少毒副作用的目的。从抗血管生成治疗、表皮生长因子受体阻断剂、聚腺苷二磷酸核糖聚合酶(PARP)抑制剂、免疫检查点抑制剂等几个方面对靶向治疗宫颈癌的相关研究进行概述,从而为宫颈癌的生物治疗提供参考。     

Predictors of outcomes for women with cervical carcinoma

BACKGROUND: To determine the impact of race and other factors on the management and outcomes of women treated for cervical cancer in a rural state. METHODS: Following IRB approval, a retrospective review identified 434 eligible women treated for cervical cancer from 1994 to 2000. Collected data included: demographics, clinicopathologic data, primary and adjuvant therapy, recurrence, and survival. Statistical analyses were performed with the Chi-square test, Kaplan-Meier method, and Cox regression. RESULTS: 304 (70%) of the women were white and 130 (30%) were non-white. Non-whites were more likely to present with advanced stage disease [Stage IIB-IVB] (25% vs. 13%; P < 0.01). Whites were more likely to smoke, be married, be employed, and have private insurance. Non-whites were more likely to have medical co-morbidities such as diabetes and hypertension. Although whites with early stage disease were more likely to undergo surgery as their primary therapy than non-whites (93% vs. 84%; P < 0.01), survival was similar. Survival outcomes for advanced stage disease were similar between groups. CONCLUSIONS: Non-whites diagnosed with cervical cancer are more likely to present with advanced stage disease than whites; however, overall survival was similar between groups. Non-whites with early stage disease were more likely to receive primary radiation therapy than whites. The decision to use radiation therapy vs. surgery does not appear to have a detrimental effect on overall survival, but may impact quality of life.     

Gynecologic cancer in the very elderly

Due to the increasingly elderly population of the United States, it was elected to review the experience at the Cleveland Clinic Foundation in treating women older than 75 years of age for gynecologic cancer. The charts of 114 patients were reviewed to study the presentation of primary cancers, the morbidity and mortality associated with therapies, and patient survival. Cardiovascular disease, including hypertension, and diabetes mellitus were the most common associated medical problems. 36% of patients had endometrial cancer, 25% cervical cancer, 19% vulvar cancer, 12% ovarian cancer and 7% vaginal cancers. Compared to data for patients of all ages in Annual Report on the Results of Treatment in Gynecologic Cancer (Vol. 18), patients with endometrial, cervical, and vulvar cancers were of a significantly more advanced stage than expected. Therapy was modified due to patient age or medical status in 42 patients. No postoperative mortality was encountered, although patients often required multiple prolonged hospitalizations. The projected overall survival rate (Kaplan-Meier Analysis) was 44% at 5 years. It is concluded that despite their advanced age and associated medical problems, very elderly patients can usually receive definitive cancer therapies, including surgery, after careful preoperative medical evaluation and therapy.     

Intent-to-treat analysis of stage Ib and IIa cervical cancer in the United States: radiotherapy or surgery 1988-1995

OBJECTIVE: To estimate the patterns of care and outcome of women with early cervical cancer in the United States based on surgical or radiation intent-to-treat principles. METHODS: The Surveillance, Epidemiology, and End Results 1995 public-use file was the data source. Subjects between the ages of 15 and 80 years at diagnosis who were treated for stage Ib or IIa cervical cancer were identified. The 1039 women who comprised the study group were stratified according to age at diagnosis (40 years or less, older than 40 years), primary treatment intent (surgery, radiotherapy), tumor size (4 cm or less, over 4 cm), registry site, and ethnicity. Survival analyses included 784 women who had at least 2 years of follow-up. RESULTS: There were 276 cancers (26.5%) over 4 cm, and 586 (56%) women were older than 40 years at diagnosis. There were 741 (71%) subjects in the surgical intent-to-treat group, and the remainder (298) were in the radiation intent-to-treat group. Kaplan-Meier analysis indicated a 5-year survival advantage for women with tumors 4 cm or less who were in the surgical intent-to-treat group compared with the radiation intent-to-treat group (86% and 71%, P <.001). Treatment group was not prognostic for cervical cancers over 4 cm (surgical intent-to-treat compared with radiation intent-to-treat; 72% and 68% survival, respectively). Multivariable analysis confirmed a survival advantage for women with surgical intent-to-treat and tumors of 4 cm or less. CONCLUSION: In the United States there is a survival advantage for surgical intent-to-treat compared with radiation intent-to-treat for women with tumors 4 cm or less, independent of ethnicity, adjuvant therapy, or age.     

Intracranial metastases from carcinoma cervix and review of literature

Brain metastases from primary cervical carcinoma are uncommon. Only 41 cases have been reported so far in the English literature. We have seen 2 cases over the last 2 years among 481 patients with cervical cancer. Brain metastases developed 7 and 35 months after the primary diagnosis. One patient with solitary metastasis had no evidence of disease elsewhere and is free of disease after surgery and radiation therapy 7 months after the brain metastasis. Another patient with multiple brain metastases and cervical disease is alive 2 months after palliative radiation therapy.     

Primary treatment of cervical carcinoma. Ten years experience from one Norwegian health region

OBJECTIVE: To study the primary care of cervical carcinoma with regard to clinical and pathological factors, treatment decisions, complications and survival. DESIGN: A historical cohort comprising all women hospitalized with invasive cervical carcinoma (n=293) during the period 1987-1996. RESULTS: Median age was 52 years (range 23-90). FIGO stage distribution was 62%, 15%, 18% and 5% in stages I, II, III and IV, respectively. Early stage disease correlated with young age. Histologic types were: squamous cell carcinoma 84%, adenocarcinoma 11%, adenosquamous carcinoma 4% and small cell/anaplastic carcinoma 1%. Primary therapies were: surgery 188 women (64%), radiotherapy 99 women (34%), chemotherapy two women (0.7%); four women not treated (1.3%). Complications after surgery in 25 women (13%), none were fatal. Acute or late complications after primary or postoperative radiotherapy in 39 women (25%), seven (4.6%) were late serious complications. Three women died from complications related to radiotherapy. Mean follow-up of surviving patients was 58 months. Overall disease specific five-year survival was 70%. Five-year survival in stages IA, IB, II and III was 100%, 88%, 58% and 20%, respectively. One-year survival in stage IV was 31%. Median survival in stages III and IV according to curative or palliative aim of treatment was 20 and 6 months, respectively (p<0.005). CONCLUSION: Satisfactory quality of diagnosis and therapy have been maintained through regional care for cervical cancer patients.     

局部晚期宫颈癌靶向治疗的现状和未来

近年来,由于宫颈癌筛查的普及,全球宫颈癌发病率呈现下降趋势,约80%以上宫颈癌患者发生在发展中国家,而且年轻妇女宫颈癌的发生率在逐渐上升。对于晚期宫颈癌患者,虽然放疗和化疗有一定的疗效,但是中位生存时间也仅1年。靶向治疗在治疗晚期肿瘤方面取得了巨大的成就,临床研究已经证实贝伐单抗联合化疗可有效延长晚期宫颈癌患者的总生存时间,而且越来越多的靶向药物也被用于研究对晚期宫颈癌的治疗上。