Survival and prognostic factors comparing stage IB 1 versus stage IB 2 cervical cancer treated with primary radical hysterectomy

This study was undertaken to compare the survival rates of stage IB 1 versus stage IB 2 cervical cancer patients and to evaluate the prognostic factors after treatment primarily with radical hysterectomy and pelvic lymphadenectomy (RHPL). Patients with stage IB cervical cancer undergoing primary RHPL at Chiang Mai University Hospital between January 2002 and December 2009 were evaluated for survival and recurrence. Clinicopathological variables were analyzed to identify the prognostic factors affecting the survival of the patients. During the study period, RHPL was performed on 570 stage IB 1 and 110 stage IB 2 cervical cancer patients. With a median follow-up of 48 months, the 5-year disease-free survivals were 98.1% and 82.8% respectively (p<0.001). Multivariate analysis identified four significant prognostic factors affecting survival including sub-staging, non-squamous cell carcinoma histology, lymph node metastasis and the presence of lymph-vascular space invasion. In conclusion, with a primary radical hysterectomy, stage IB 1 cervical cancer patients have a significantly better survival rate than those with stage IB 2. Significant prognostic factors for stage IB cervical cancer include tumor histology, nodal status, and the presence of lymph-vascular space invasion.     

Comparative study of neoadjuvant chemotherapy before radical hysterectomy and radical surgery alone in stage IB2-IIA bulky cervical cancer

Objective

To compare the efficacy of neoadjuvant chemotherapy with paclitaxel plus platinum followed by radical hysterectomy with radical surgery alone in patients with stage IB2-IIA bulky cervical cancer.

Methods

From November 1999 to September 2007, stage IB2-IIA cervical cancers with tumor diameter >4 cm, as measured by MRI, were managed with two cycles of preoperative paclitaxel and platinum. As a control group, we selected 35 patients treated with radical surgery alone.

Results

There were no significant between group differences in age, tumor size, FIGO stage, level of SCC Ag, histopathologic type and grade. Operating time, estimated blood loss, the number of lymph nodes yielded and the rate of complications were similar in the two groups. In surgical specimens, lymph-vascular space invasion (LVSI), nodal metastasis and parametrial involvement did not differ significantly between the two groups. In the neoadjuvant group, pathologic tumor size was significantly smaller and fewer patients had deep cervical invasion. Radiotherapy, alone and in the form of concurrent chemoradiation, was administered to more patients treated with radical surgery alone (82.9% vs. 52.9%, p=0.006). No recurrence was observed in patients who could avoid adjuvant radiotherapy owing to improved risk factors after neoadjuvant chemotherapy. There were no significant differences in 5-year disease free and overall survival.

Conclusion

As neoadjuvant chemotherapy would improve pathologic prognostic factors, adjuvant radiotherapy can be avoided, without worsening the prognosis, in patients with locally advanced bulky cervical cancer. Neoadjuvant chemotherapy would be improving the quality of life after radical hysterectomy in patients with bulky cervical cancer.     

Neo-adjuvant platinum-based chemotherapy followed by chemoradiation and radical surgery in locally advanced cervical cancer (Lacc) patients: A phase II study

Purpose

The aim of this Phase II, non-randomized study was to assess activity and safety of neoadjuvant chemotherapy (NACT) before chemoradiation (CT/RT) followed by radical surgery (RS) in locally advanced cervical cancer (LACC) patients.

Locoregional Spread and Survival of Stage IIA1 versus Stage IIA2 Cervical Cancer

This study was undertaken to compare surgical outcomes and survival rates of patients with the 2009International Federation of Gynecology and Obstetrics (FIGO) stage IIA1 versus IIA2 cervical cancer treatedwith radical hysterectomy and pelvic lymphadenectomy (RHPL). Patients with stage IIA cervical cancerundergoing primary RHPL between January 2003 and December 2012 at Chiang Mai University Hospital wereretrospectively reviewed. The analysis included clinicopathologic variables, i.e. nodal metastasis, parametrialinvolvement, positive surgical margins, deep stromal invasion (DSI)), lymph-vascular space invasion (LVSI),adjuvant treatment, and 5-year survival. The chi square test, Kaplan-Meier method and log-rank test were usedfor statistical analysis. During the study period, 133 women with stage IIA cervical cancer, 101 (75.9 %) stageIIA1, and 32 (24.1 %) stage IIA2 underwent RHPL. The clinicopathologic variables of stage IIA1 comparedwith stage IIA2 were as follows: nodal metastasis (38.6% vs 40.6%, p=0.84), parametrial involvement (10.9% vs15.6%, p=0.47), positive surgical margins (31.7% vs 31.3%, p=1.0), DSI (39.6% vs 53.1%, p=0.18), LVSI (52.5%vs 71.9%, p=0.05) and adjuvant radiation (72.3% vs 84.4%, p=0.33). With a median follow-up of 60 months,the 5-year disease-free survival (84.6% vs 88.7%, p=0.67) and the 5-year overall survival (83.4% vs 90.0%,P=0.49) did not significantly differ between stage IIA1 and stage IIA2 cervical cancer. In conclusion, patientswith stage IIA1 and stage IIA2 cervical cancer have comparable rates of locoregional spread and survival. Theneed for receiving adjuvant radiation was very high in both substages. The revised 2009 FIGO system did notdemonstrate significant survival differences in stage IIA cervical cancer treated with radical hysterectomy.Concurrent chemoradiation should be considered a more suitable treatment for patients with stage IIA cervicalcancer.     

Cost-utility analysis of treatments for stage IB cervical cancer

Objective

To analyze the cost-utility of two common clinical practices for stage IB cervical cancer patients from provider and societal viewpoints.

Methods

A decision tree model was conducted to examine value for expenditure between the following: (1) radical hysterectomy with pelvic lymph node dissection (RHPLND) with or without postoperative adjuvant therapy according to the risk of recurrence and (2) concurrent chemoradiotherapy (CCRT). The relevant studies were identified to extract the probability data, and meta-analysis was performed. Direct medical costs were estimated from hospital database and medical records review. Direct non-medical costs and utility parameters were obtained through interviews with patients to estimate quality-adjusted life years (QALYs) outcome. The time horizon was according to the life expectancy of Thai women.

Results

From provider viewpoint, RHPLND and CCRT resulted in approximate costs of US $5,281 and US $5,218, respectively. The corresponding costs from societal viewpoint were US $6,533 and US $6,335, respectively. QALYs were 16.40 years for RHPLND and 15.94 years for CCRT. The estimated incremental cost effectiveness ratio of RHPLND in comparison to CCRT from provider and societal viewpoints were US $100/QALY and US $430/QALY, respectively. RHPLND had more cost-effectiveness than CCRT if patients did not need adjuvant therapy. The most effective parameter in model was a direct medical cost of CCRT. At the current ceiling ratio in Thailand, RHPLND provides better value for money than CCRT, with a probability of 75%.

Conclusion

RHPLND is an efficient treatment for stage IB cervical cancer. This advantage is only for patients who require no adjuvant treatment.     

Class I versus class III radical hysterectomy in stage IB1-IIA cervical cancer. A prospective randomized study

Objective

The standard treatment for stage IB-IIA cervical cancer over the past three decades has been the Piver–Rutledge type III radical hysterectomy. This surgery implies a high rate of urologic morbidity. The objective was to determine the role of class I radical hysterectomy compared to class III radical hysterectomy in terms of morbidity, overall survival, DFS and patterns of relapse in patients undergoing primary surgery.

Materials and methods

125 patients with stage IB1 and IIA cervical cancer ≤4 cm were randomized between type I and type III hysterectomy. Clinical, pathologic and follow-up data were prospectively collected. Adjuvant radiotherapy was administered when indicated. Univariate and multivariate analyses were carried out.

Results

Sixty-two patients were randomized to class I surgery and 63 to class III. No significant differences were observed regarding pathologic findings and adjuvant treatment. Morbidity rates were higher after class III surgery (84% versus 45%). Pelvic recurrences were equal in both groups (8 cases each one). Fifteen-year overall survival rate was 90 and 74% respectively (p = 0.11) and 76 and 80% when cervical size is ≤3 cm (p = 0.88).

Conclusions

There are no significant differences in terms of both recurrence rate and overall survival among patients with stage IB-IIA cervical cancer undergoing simple extrafascial hysterectomy (class I) or radical hysterectomy (class III). Morbidity is proportional to the extent of radicality. These data confirm the need of tailoring the extent of resection to the characteristics of the cervical neoplasia and open new interesting pathways to upcoming protocols for the conservative management of these tumors.     

腹腔镜在早期宫颈癌根治术中的应用效果评价

目的 探讨腹腔镜手术治疗早期宫颈癌的可行性、安全性及临床价值。方法 收集2009年1月至2014年12月在广西医科大学附属肿瘤医院妇瘤科行宫颈癌根治术的623例早期宫颈癌患者的病历资料,按手术方式分组：腹腔镜组374例,开腹组249例。回顾性分析两组患者的基本情况、手术时间、术中出血量、术中淋巴结切除数目、宫旁组织及阴道切除长度及手术并发症。结果 腹腔镜手术组成功实施368例,成功率98.40％（368／374）,中转开腹6例,中转开腹率1.60％ （6／374）。腹腔镜组在手术时间、术中出血量、术后下床活动时间、肛门排气时间均优于开腹组,差异均有统计学意义（P＜0.05）,而两组淋巴结切除数、宫旁组织和阴道切除长度比较,差异均无统计学意义（P＞0.05）。在术中及术后并发症方面,除尿潴留外,两组差异均无统计学意义（P＞0.05）。结论 腹腔镜下宫颈癌根治术较传统开腹手术创伤小、术中出血量少、术后并发症少及术后恢复快,是治疗早期宫颈癌有效、安全的方法。     

Extent of disease and results of adjuvant radiotherapy after radical hysterectomy and pelvic lymphadenectomy in the treatment of stage IB, IIA, and IIB cervical carcinoma

Background. To identify variable prognostic factors and analyze failure patterns in uterine cervix cancer after radical operation and adjuvant radiotherapy, a retrospective analysis was undertaken. Methods. We analyzed 124 patients with uterine cervix cancer, FIGO stage IB, IIA, and IIB, treated with radical hysterectomy and pelvic lymph node dissection followed by adjuvant radiotherapy between May 1985 and May 1995. Minimum follow-up period was 24 months. All these patients were treated with full-dose external radiotherapy using a linear accelerator or high-dose-rate intracavitary radiation. Results. Overall 5-year survival rate and relapse-free survival rate were 75.4% and 73.5%, respectively. Significant prognostic factors for relapse-free survival were wall involvement thickness, lymph node location and number, parametrium involvement, tumor size, stage, uterine body involvement, and vaginal resection margin involvement. By multivariate analysis, lymph node metastasis, tumor size, and vaginal resection margin involvement were significant prognostic factors. Treatment-related failure occurred in 33 cases. In stage IIB, 5-year relapse-free survival rate was only 56%, and 9 of 22 patients had recurrence. Conclusion. Postoperative radiotherapy results are good for patients with relatively low risk factors, but the results are poor for patients with multiple high-risk factors or stage IIB. To control recurrence for patients with high-risk factors, postoperative adjuvant radiotherapy alone is not a sufficient treatment method. Considering cost-effectiveness, it may be reasonable to treat with primary radical radiotherapy for patients with stage IIB cervical cancer and poor prognostic factors instead of a radical operation and adjuvant radiotherapy or chemotherapy regimen. Further investigation should be done. Received: November 13, 1998 / Accepted: May 27, 1999     

Comparison of oncological outcomes and major complications between laparoscopic radical hysterectomy and abdominal radical hysterectomy for stage IB1 cervical cancer with a tumour size less than 2 cm

ObjectiveTo compare the oncological outcomes and major complications of laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH) for stage IB1 cervical cancer (FIGO 2009) with a tumour size less than 2 cm.MethodsWe retrospectively compared the oncological outcomes and major complications of 1207 stage IB1 cervical cancer patients with a tumour size less than 2 cm who received LRH (n = 546) or ARH (n = 661) in 37 hospitals.Results(1) There was no significant difference in 3-year overall survival (OS; 97.3% vs. 98.5%, P = 0.288) or 3-year disease-free survival (DFS; 95.1% vs. 95.4%, P = 0.792) between LRH (n = 546) and ARH (n = 661).(2) The rate of any 1 complication refers to the incidence of one or more complications in a patient, which was higher with LRH than ARH (OR = 4.047, 95% CI = 2.035–8.048, P < 0.001). Additionally, intraoperative complications occurred with LRH (OR = 12.313, 95% confidence intervals [CI] = 1.571–96.493, P = 0.017), and postoperative complications (OR = 3.652, 95% CI = 1.763–7.562, P < 0.001) were higher with LRH than ARH. The ureteral injury rate was higher with LRH than with ARH (1.50% vs. 0.20%, OR = 9.814, 95% CI = 1.224–78.712, P = 0.032). The ureterovaginal fistula rate was higher with LRH than ARH. The rates of obturator nerve injury, bladder injury, vesicovaginal fistula, rectovaginal fistula, venous thromboembolism, bowel obstruction, chylous leakage, pelvic haematoma, and haemorrhage were similar between the groups.ConclusionsThe oncological outcomes of LRH and ARH for stage IB1 cervical cancer patients with a tumour size less than 2 cm do not differ significantly. However, incidences of any 1 complication, intraoperative complications, and postoperative complications were higher with LRH than ARH, with complications manifesting mainly as ureteral injury and uterovaginal fistula.     

A phase II study of multimodality treatment for locally advanced cervical cancer: neoadjuvant carboplatin and paclitaxel followed by radical hysterectomy and adjuvant cisplatin chemoradiation.

BACKGROUND: Our aim was to evaluate the efficacy and safety of neoadjuvant chemotherapy followed by radical hysterectomy and adjuvant radiation concurrent with weekly cisplatin for locally advanced cervical carcinoma. PATIENTS AND METHODS: Forty-three patients staged as IB2-IIIB were treated with three 21-day courses of carboplatin (area under the time-concentration curve 6 mg.min/ml) and paclitaxel at 175 mg/m(2) by 3-h infusion both on day 1 followed by radical type III hysterectomy and adjuvant radiation concurrent with 6-weekly doses of cisplatin at 40 mg/m(2). Response rate, resectability, toxicity and survival were evaluated. RESULTS: From December 2000 to June 2001, 43 patients were recruited. All were evaluated for response and toxicity to neoadjuvant chemotherapy. A total of 129 courses were administered. Clinical responses were seen in 41 patients (95%) [95% confidence interval (CI) 89.2% to 100%] with four (9%) complete and 37 (86%) partial. Forty-one patients underwent surgery (resectability 95%); pathologically complete or near-complete responses were seen in seven (17%) and eight (20%), respectively, positive surgical margins in five (12%), and positive pelvic lymph nodes in eight (20%). Twenty-six patients were scheduled for adjuvant chemoradiation. External radiation was delivered for 42.8 days (range 33-61), with a mean dose of 49.3 Gy (range 46-56), and a median of five cisplatin courses (two to six). The mean dose of brachytherapy was 32 Gy (range 25.5-35.6). Neoadjuvant therapy was well-tolerated with neutropenia grade 3 and 4 in 12% and 3% of the courses, respectively. Toxicity to adjuvant chemoradiation was mainly hematological and gastrointestinal, mostly grades 1/2. A total of 39 patients completed all scheduled treatment. At a median follow-up of 21 months (range 3-26), the projected overall survival in the intention-to-treat analysis was 79% (95% CI 62% to 88%). CONCLUSIONS: The triple modality of neoadjuvant chemotherapy followed by radical hysterectomy and adjuvant radiation concurrent with cisplatin is a highly active treatment for locally advanced cervical carcinoma with acceptable toxicity.     

宫颈癌保留盆腔神经的广泛子宫切除术的疗效分析

目的:探讨保留神经的广泛子宫切除手术的可行性.方法:2011年1月至2015年12月,陕西省肿瘤医院收治57例子宫颈癌(诊断为Ⅰa2-Ⅱa期)患者,按纳入和排除标准随机分为两组,A组27例,实施保留盆腔神经的广泛子宫切除术(NSRH);B组30例,实施广泛子宫切除术加盆腔淋巴结清扫术(RH),比较两组间的总手术时间、术中失血量、宫旁及阴道切除长度、切除淋巴结数量及膀胱、直肠功能恢复情况.结果:两组患者均顺利完成手术,保留组总手术时间、术中失血量、宫旁及阴道切除长度、切除淋巴结数量等方面与对照组比较,两组间差异无统计学意义(P>0.05);拔除尿管平均时间(213.2±60.4)h、术后残余尿量(50.7±7)ml、肛门排气时间(53.2±4.3)min、术后排便时间(72.4±3.3)min与对照组(297.6 ±72)h、(70.8±9)ml、(68.1±5.6)min、(89.5±6.7)min比较,两组间差异有统计学意义(P<0.05).术后随访3~24个月,两组患者排便、排尿无异常,均无复发、转移及死亡病例.结论:NSRH有利于术后膀胱、直肠功能恢复,对早期宫颈癌治疗具有安全性和可行性.     

Results of the GYNECO 02 study, an FNCLCC phase III trial comparing hysterectomy with no hysterectomy in patients with a (clinical and radiological) complete response after chemoradiation therapy for stage IB2 or II cervical cancer

Background.

Concomitant chemoradiation (CRT) (including brachytherapy) is considered the standard management for stage IB2 or II cervical cancer in many countries. Nevertheless, some of them discuss completion surgery (hysterectomy [HT]) after CRT. The aim of this study was to investigate the therapeutic impact of such surgery.

Methods.

A randomized trial was opened in France in 2003 to evaluate the interest in HT after CRT. Inclusion criteria were: (a) stage IB2 or II cervical cancer without extrapelvic disease on conventional imaging; (b) pelvic external radiation therapy (45 Gy with or without parametrial or nodal boost) with concomitant cisplatin chemotherapy (40 mg/m² per week) followed by uterovaginal brachytherapy (15 Gy to the intermediate risk clinical target volume); and (c) complete clinical and radiological response 6–8 weeks after brachytherapy. Patients were randomized between HT (arm A) and no HT (arm B). Unfortunately this trial was closed because of poor accrual: 61 patients were enrolled (in 2003–2006) and are reported on here.

Results.

Thirty one and 30 patients were enrolled, respectively, in arm A and arm B. Twelve patients recurred (five of them died): respectively, eight and four in arm A and arm B. The 3-year event-free survival rates were 72% (standard error [SE], 9%) and 89% (SE, 6%) (not significant [NS]) in arm A and arm B, respectively. The 3-year overall survival rates were 86% (SE, 6%) and 97% (SE, 3%) (NS) in arm A and arm B, respectively.

Conclusions.

Results of the current trial seem to suggest that completion HT had no therapeutic impact in patients with clinical and radiological complete response after CRT (but this conclusion is limited by the lack of power).     

Prevalence and characteristics of late postoperative voiding dysfunction in early-stage cervical cancer patients treated with radical hysterectomy.

BACKGROUND: Although effective as a primary treatment for early-stage cervical cancer, radical hysterectomy is associated with significant long-term morbidities, most commonly, voiding dysfunction. OBJECTIVE: To examine prevalence and characteristics of voiding dysfunction following radical hysterectomy for early-stage cervical cancer. METHODS: One hundred-eighty seven patients with FIGO stage IA2-IIA cervical cancer who underwent class II-III radical hysterectomy with systematic pelvic lymphadenectomy between January 1, 2002 and June 31, 2005 were interviewed with questionnaire on voiding function. Medical records were also reviewed for operative and pathologic data. RESULTS: The prevalence of symptomatic bladder dysfunction was 25.1%. There was no statistically significant association between rates of bladder dysfunction and all examined clinical/operative factors. The most common pattern of bladder dysfunction were incomplete emptying in 25 (13.4%) and urgency and nocturia in 21 (11.2%) each. CONCLUSION: Voiding dysfunction is a common and clinically significant long-term complication following radical hysterectomy. The pattern of dysfunction reflects combined surgical disruption of both parasympathetic and sympathetic innervations of the pelvis.     

Feasibility of concurrent cisplatin use during primary and adjuvant chemoradiation therapy: a phase I study in Japanese patients with cancer of the uterine cervix

Background Although the prognostic advantages of concurrent cisplatin (CDDP) chemoradiation therapy (CCRT), for uterine cervical cancer (UCC) has been demonstrated, the feasibility of concurrent CDDP administration has not yet been evaluated. We determined the optimal CDDP dose for both weekly and monthly schedules during primary and adjuvant CCRT in patients with UCC. Methods The study was conducted as a phase I, dose-escalation trial. Concurrent CDDP was started at the dose of 30 mg/m² for the weekly schedule and at 50 mg/m² for the monthly schedule, and the doses were steadily escalated to the maximum tolerated dose (MTD). Results A total of 45 patients with UCC (25 receiving primary CCRT and 20 receiving adjuvant CCRT) were entered in the study. In both the primary and adjuvant CCRT patients, the MTD was observed to be 40 mg/m² for the weekly schedule and 80 mg/m² for the monthly schedule. Dose-limiting toxicity was observed in 10 patients (granulocytopenia in 9 patients and diarrhea in 1 patient). Disease recurrence was confirmed in 6 patients in the primary CCRT group during a mean follow-up period of 22.4 ± 13.2 months, and in patients 3 in the adjuvant CCRT group during a mean follow-up period of 17.7 ± 6.8 months. Conclusion For Japanese patients with UCC receiving primary or adjuvant CCRT therapy, the recommended CDDP dose was determined to be 30 mg/m² for the weekly schedule and 75 mg/m² for the monthly schedule.     

Different strategies of treatment for uterine cervical carcinoma stage IB2-IIB

Uterine cervical cancer is the second most common gynecological malignancy. It is estimated that over 35% of tumors are diagnosed at locally advanced disease, stage IB2-IIB with an estimated 5-year overall survival of 60%. During the last decades, the initial treatment for these women has been debated and largely varies through different countries. Thus, radical concurrent chemoradiation is the standard of care in United Sated and Canada, and neoadjuvant chemotherapy followed by radical surgery is the first line of treatment in some institutions of Europe, Asia and Latin America. Until today, there is no evidence of which strategy is better over the other. This article describe the evidence as well as the advantages and disadvantages of the main strategies of treatment for women affected by uterine cervical cancer stage IB2-IIB.     

早期宫颈癌术后中危因素定义及辅助治疗的研究进展北大核心CSCD

宫颈癌仍是中国常见的妇科肿瘤疾病。早期宫颈癌(FIGO分期ⅠB-ⅡA期)的治疗常常首选根治性手术,术后病理往往存在不良预后因素影响患者的生存。根据NCCN指南推荐,存在中危因素(淋巴血管间隙受累、肿瘤大小或深层间质浸润)且符合Sedlis标准的宫颈癌患者,建议术后补充盆腔外照射±含顺铂同步化疗。但是目前早期宫颈癌术后中危因素的定义标准、辅助治疗的指征及方式仍存在争议,本文重点阐述早期宫颈癌根治术后中危因素的定义标准及辅助治疗的研究进展。     

早期宫颈癌术后中危因素定义及辅助治疗的研究进展

宫颈癌仍是中国常见的妇科肿瘤疾病。早期宫颈癌（FIGO分期ⅠB‐ⅡA期）的治疗常常首选根治性手术,术后病理往往存在不良预后因素影响患者的生存。根据NCCN指南推荐,存在中危因素（淋巴血管间隙受累、肿瘤大小或深层间质浸润）且符合Sedlis标准的宫颈癌患者,建议术后补充盆腔外照射±含顺铂同步化疗。但是目前早期宫颈癌术后中危因素的定义标准、辅助治疗的指征及方式仍存在争议,本文重点阐述早期宫颈癌根治术后中危因素的定义标准及辅助治疗的研究进展。     

瑞芬太尼对宫颈癌根治术应激反应的影响

目的:研究瑞芬太尼麻醉对宫颈癌根治术应激反应的影响.方法:60例宫颈癌根治术患者,随机分为两组:瑞芬太尼组(R组)30例和芬太尼组(F组)30例.R组:瑞芬太尼1ìg,继以0.2ìg/(kg穖in)静脉泵注.F组:芬太尼3ìg/kg,继以0.03ìg/(kg穖in)静脉泵注.记录术前、术中血压、心率变化,测定麻醉前、切皮后60min、切皮后120rain的血清肾上腺素、去甲肾上腺素、皮质醇、胰岛素和血糖水平.结果:两组切皮后60min、120min的血清肾上腺素、去甲肾上腺素、皮质醇水平均高于术前(P＜0.05),切皮后60min、切皮后120rain的肾上腺素、去甲肾上腺素、皮质醇和血糖水平R组高于F组(P＜0.05).R组血糖浓度在切皮后60 min和120 min与术前相比无明显变化(P＞0.05),F组血糖浓度在切皮后60min和120min与术前比较均明显增高(P＜0.05).结论:瑞芬太尼能够减轻宫颈癌根治术时应激反应所导致的肾上腺素、去甲肾上腺素、皮质醇和血糖水平增高.     

子宫颈癌术后辅助性放疗不同照射技术临床比较研究

目的 子宫颈癌术后病理存在高危因素的患者,术后辅助放疗可提高疗效,改善预后.常用的放疗技术有调强放射治疗(intensity modulated radiotherapy,IMRT)、三维适形放疗(three-dimensional conformal radiotherapy,3D-CRT)和常规放疗(conventional radiotherapy,CRT),本研究旨在比较这3种放疗技术的剂量学、毒副作用、疗效及生存情况的差异,从而找出一种更佳的放疗方案.方法 选取2009-01-10-2015-07-10临沂市肿瘤医院接受放疗的341例宫颈癌术后存在高危因素患者,分为IMRT组患者128例、3D-CRT组患者77例和CRT组患者136例.IMRT组PTV 50.4~54 Gy,3D-CRT组PTV45~50.4 Gy,CRT组处方剂量DT41.4~45 Gy.体外放疗同时给予化疗.随机选取10例患者重新制定IMRT计划、3D-CRT计划和CRT计划.采用SPSS 22.0统计软进行数据分析,比较危及器官(organ at risk,OAR)受照射剂量、靶区剂量、急慢性毒副作用、疗效及生存情况.结果 IMRT计划、3D-CRT计划和CRT计划的OAR受照射剂量差异有统计学意义(脊髓F=1 070.038,P<0.001;股骨头F=103.277,P<0.001;小肠F=208.677,V=13.776,P<0.001;膀胱F=303.481,V=13.330,P<0.001;直肠F=230.452,V=13.272,P<0.001.3组患者的靶区剂量差异有统计学意义,χ2=293.059,P<0.001.IMRT组与3D-CRT组比较,Z=-11.096,P<0.001;IMRT组与CRT组比较,Z=-14.281,P<0.001;3D-CRT组与CRT组比较,Z=-12.401,P<0.001,差异均有统计学意义.3组的急性消化道反应(χ2=11.848,P=0.003)、泌尿系统反应(χ2=10.390,P=0.006)、骨髓抑制(χ2=14.154,P=0.001)、慢性消化道反应(χ2=19.242,P<0.001)、泌尿系统反应(χ2=15.670,P<0.001)差异均有统计学意义.3组靶区内外转移率比较显示,IMRT组靶区内复发率有降低趋势,但无统计学意义(χ2=5.327,P=0.070),靶区外转移率差异无统计学意义,χ2=1.370,P=0.504.3组无瘤生存期(disease-free survival,DFS)差异无统计学意义(P=0.054),其中IMRT组较CRT组明显提高(P=0.013),IMRT组较3D-CRT组差异无统计学意义(P=0.123),3D-CRT组较CRT组差异无统计学意义(P=0.532).3组总生存期(overall survival,OS)差异有统计学意义(P=0.024),其中IMRT组OS较CRT组明显提高(P=0.008), IMRT组较3D-CRT组差异无统计学意义(P=0.259),3D-CRT组较CRT组差异无统计学意义,P=0.213.将宫旁受侵、淋巴转移、深肌层受侵、脉管癌栓、靶区内外转移进行多因素分析,深肌层受侵是患者独立预后不良因素,P=0.047,HR=2.362,95%CI为1.013~5.508.结论 对宫颈癌术后具有不良预后因素患者,IMRT可获得理想的剂量分布,IMRT技术与其他技术相比具有明显剂量学优势,OAR受照射剂量降低,靶区剂量明显提高,毒副作用减少,靶区内复发率有降低趋势,总生存率提高.