子宫肉瘤治疗新进展

子宫肉瘤是一种少见的子宫恶性肿瘤,恶性程度高,易局部复发及远处转移,预后不佳。手术为主要的治疗方法,强调术后治疗的规范化及个体化。术后放射治疗并不能改善子宫平滑肌肉瘤患者的无瘤生存率和整体生存率,辅助性化疗因能提高子宫癌肉瘤患者的整体生存率而成为标准治疗方案。曲贝替定用于治疗晚期子宫平滑肌肉瘤有效且安全。靶向药物治疗子宫肉瘤仍处于研究探索阶段。     

46例子宫肉瘤临床病理分析

１９８０年６月至１９９０年６月收治子宫肉瘤４６例，占收治的子宫恶性肿瘤１９２６例的２．３％，其中Ⅰ期１０例、Ⅱ期６例、Ⅲ期２５例、Ⅳ期５例。４６例均有病理证实，其中平滑肌肉瘤２８例，内膜间质肉瘤６例，内膜间质异位症４例，中胚叶混合瘤型５例，癌肉瘤型３例，好发于肌层，光镜下见癌细胞密集，排列紊乱，大小形态不一，核异型性明显，核染色质深，核膜不清，核仁明显，核分裂像多在５／１０ＨＰＬ可见瘤巨细胞及多核瘤巨细胞。治疗以手术为主，辅之以化疗和（或）放疗。     

子宫肉瘤放射治疗的临床观察

目的　观察子宫肉瘤对手术后辅助放射治疗（放疗）的疗效,及原发肿瘤或复发肿瘤对放疗的反应。方法　回顾分析我院1960年5月～1999年6月收治的子宫肉瘤102例,其中单纯手术组45例,手术+放疗组29例,单纯放疗组4例,复发肿瘤放疗组24例。结果　5年生存率,单纯手术组为56.7%,手术+放疗组为58.6%,两组比较,差异无显著性（P>0.05）。局部复发率,单纯手术组为42.2%,手术+放疗组为20.7%,两组比较,差异有显著性（P<0.05）。单纯放疗组4例中有3例肿瘤完全消失,其中1例生存时间达36个月,另2例于放疗后9个月和11个月死于远处转移。复发肿瘤放疗组有效率达50.0%。放射敏感性依次为子宫内膜间质肉瘤、子宫恶性苗勒管混合瘤、子宫平滑肌肉瘤。结论　子宫肉瘤手术后放疗可明显减少盆腔复发,放疗应作为子宫肉瘤综合治疗的一部分。     

子宫平滑肌肉瘤治疗进展

子宫平滑肌肉瘤是一种较少见的恶性肿瘤,诊断依赖病理.治疗方法以手术治疗为主,全子宫加双附件切除是标准术式,特殊情况下,也可以保留卵巢或保留生育能力.辅助治疗以化疗为主,化疗方案纷繁复杂,化疗药物包括阿霉素、异环磷酰胺等多种.就子宫平滑肌肉瘤的各种治疗方案作一综述.     

子宫平滑肌肉瘤治疗进展

子宫平滑肌肉瘤是一种较少见的恶性肿瘤，诊断依赖病理。治疗方法以手术治疗为主，全子宫加双附件切除是标准术式，特殊情况下，也可以保留卵巢或保留生育能力。辅助治疗以化疗为主，化疗方案纷繁复杂，化疗药物包括阿霉素、异环磷酰胺等多种。就子宫平滑肌肉瘤的各种治疗方案作一综述。     

子宫肉瘤辅助治疗

子宫肉瘤(uterine sarcoma)是一种发病罕见、恶性程度高的疾病,占所有子宫体恶性肿瘤的3%~7%。该病发病隐匿,组织学类型多样,至今仍未建立标准治疗方案。目前首选治疗方式为手术治疗,但术后复发率依然居高不下,严重影响患者远期生存率。因此子宫肉瘤的术后辅助治疗已成为国内外研究焦点之一,但对其可靠性及有效性目前仍无定论。本文总结了常见类型子宫肉瘤术后辅助治疗的研究现状及进展,特别是对子宫平滑肌肉瘤和低级别子宫内膜间质肉瘤术后辅助治疗方法进行罗列与分析,以期为临床提供相应治疗思路。     

子宫肉瘤的化疗及其进展

子宫肉瘤是一组来源于子宫间质、结缔组织或平滑肌的恶性肿瘤，病理类型主要有子宫平滑肌肉瘤(LMS)、子宫内膜间质肉瘤(ESS)以及子宫恶性中胚叶混合瘤(MMT，亦称恶性苗勒管混合瘤或癌肉瘤)。子宫肉瘤临床少见，约占妇科恶性肿瘤的1％～3％，其临床特点是易于出现局部复发和远处转移，即使是早期病例也不例外，以至于5年存     

子宫肉瘤研究进展

子宫肉瘤是发生于女性生殖器官的恶性肿瘤，其发病率低、预后差，主要有异常阴道出血、腹痛、腹部包块等临床表现。血清乳酸脱氢酶、血清中性粒细胞与淋巴细胞比值（NLR）等血清学指标及超声和磁共振成像等影像学检查可协助子宫肉瘤的术前诊断，但目前其诊断仍主要依靠术后病理结果。子宫肉瘤主要有子宫平滑肌肉瘤、子宫内膜间质肉瘤及子宫腺肉瘤3种病理类型。全子宫及双附件切除是标准手术方式，术后可根据不同病理类型及手术分期选择辅助治疗方式。通过查阅国内外文献，综述子宫肉瘤的临床表现、辅助检查、病理特征、治疗及预后等。     

子宫内膜间质肉瘤的治疗

子宫内膜问质肉瘤(ESS)是一种少见的子宫恶性肿瘤，缺乏大样本的治疗学研究，相关文献比较分散，总结这些分散的文献，希望找出治疗上的规律性，作为临床处理的参考。ESS的治疗以手术为主，全子宫加双附件切除是标准术式。辅助治疗以放疗或激素治疗为主，化疗方案比较凌乱，主要化疗药物包括阿霉素、氮烯眯胺、异环磷酰胺、顺铂等多种。就ESS的各种治疗方法做一综述。     

子宫腺肉瘤

子宫腺肉瘤是子宫肉瘤的罕见类型.由良性腺上皮成分和肉瘤间质成分构成,多发在绝经后老年妇女.多表现为阴道出血和宫颈脱出息肉状肿物,治疗上以手术治疗为主,辅以化疗.既往相关报道很少,对其临床表现、病理诊断和治疗作一综述,以资借鉴.     

Reexploration after treatment for uterine sarcoma

Eleven patients treated with combination chemotherapy and radiotherapy for uterine sarcoma were reexplored after an interval of therapy. In none of the eight patients who were free of persistent sarcoma at the time of reexploration, did tumor recur during the period of follow-up. Two patients had all macroscopically visible residual sarcoma resected at reexploration and remain free of disease. The second-look laparotomy after a period of therapy may provide valuable prognostic information for planning therapy for patients who have metastatic or locally recurrent sarcoma.     

Role of radiotherapy treatment of uterine sarcoma

Uterine sarcomas are rare and, consequently, data supporting the use of adjuvant radiotherapy in uterine sarcomas consist of few randomised studies and multiple single-institution retrospective reports. It is becoming increasingly clear that each histologic subtype of uterine sarcoma is a distinct entity for which tailored treatment recommendations are needed. In this review, we analysed the effect of adjuvant radiotherapy for the main histologic subtypes of uterine sarcomas. When grouping all histologies, adjuvant radiotherapy has been shown in most studies to reduce local-regional failure without an overall survival advantage, as distant failure is the predominant pattern of relapse. Carcinosarcomas have the strongest indication for adjuvant radiotherapy, especially in early stage disease. Women with leiomyosarcomas and endometrial stromal sarcomas receiving adjuvant radiotherapy have improved local control compared with women undergoing surgery alone. As distant failure rates decrease with improvements in systemic therapies, there may be a broader indication for adjuvant radiotherapy.     

The role of adjuvant chemotherapy in the treatment of uterine sarcoma patients

41 uterine sarcoma patients completed their post-operative adjuvant treatment at Istanbul University, Oncology Institute. Of these patients 23 had pelvic irradiation (RT group) and 18 had pelvic irradiation plus chemotherapy (RT + CT group). The 3 year survival rates of the two adjuvant treatment arms were 36% (RT group) and 66% (RT + CT group) (0.05 greater than p greater than 0.02). This difference is statistically significant. The 5 year survival rates were 18% (RT group) and 51% (RT + CT group) (0.1 greater than p greater than 0.05). Although the survival advantage at 5 years is not statistically significant because of the low number of patients, the use of adjuvant chemotherapy in uterine sarcomas seems to bring some survival benefit, probably by controlling subclinical distant disease.     

Epithelioid sarcoma of the uterine cervix

BACKGROUND: Epithelioid sarcoma is a rare, yet aggressive soft tissue neoplasm that has not previously been reported to originate in the cervix. CASE: A 29-year-old woman was seen in consultation at our institution after having been diagnosed with a poorly differentiated carcinoma of the cervix, which was treated with radiation and chemotherapy. Examination of the original biopsy material with additional studies led to a diagnosis of epithelioid sarcoma of the cervix. CONCLUSION: Epithelioid sarcoma can occur in the cervix and should be included in the differential diagnosis of cervical neoplasms. Additional cases are needed to develop optimum treatment strategies and predict prognosis.     

Granulocytic sarcoma of the uterine cervix

Granulocytic sarcoma (GS) is a rare manifestation of leukemia and has been reported in 3-5% of acute myelogenous leukemia (AML) patients. GS in the uterine cervix is very rare and is also called chloroma because of its greenish appearance. We present the case of a patient whose disease relapsed as chloroma of the uterine cervix after bone marrow transplantation (BMT). She remained in continuous complete remission for 2 years after allogeneic BMT. However, she visited the hospital because of painless vaginal bleeding. She was diagnosed as having chloroma by cervical smear and colposcopically directed biopsy of the cervix. Systemic chemotherapy was administered on the presumption that myelogenous leukemia had recurred as chloroma, and a good clinical response was achieved. We describe the first case of AML that relapsed as chloroma of the uterine cervix after complete remission of the AML, which had complete response to only systemic chemotherapy.