Randomized study of preoperative radiation and surgery or irradiation alone in the treatment of stage IB and IIA carcinoma of the uterine cervix: final report

A prospective randomized study in selected patients with Stage IB and IIA carcinoma of the uterine cervix was carried out at Washington University between January 1966 and December 1979. Patients were randomized to be treated with irradiation alone consisting of 1000 cGy whole pelvis, additional 4000 cGy to the parametria with a step wedge midline block, and two intracavitary insertions for 7500 mgh; or irradiation and surgery, consisting of 2000 cGy whole pelvis irradiation, one intracavitary insertion for 5000-6000 mgh followed 2 to 6 weeks later by a radical hysterectomy with pelvic lymphadenectomy. A total of 40 patients with Stage IB and 16 with Stage IIA were randomized to be treated with irradiation alone. A similar group of 48 patients with Stage IB and 14 with IIA were randomized to the preoperative radiation and surgery group. The 5-year, tumor-free actuarial survival for Stage IB patients treated with radiation was 89% and with preoperative radiation and surgery 80%. In Stage IIA, the tumor-free actuarial 5-year survival was 56% for the irradiation alone group and 79% for the patients treated with preoperative radiation and radical hysterectomy. In the patients with Stage IB treated by irradiation alone only one pelvic failure combined with distant metastasis occurred, and 3 patients developed distant metastasis. In the 48 patients treated with combined therapy, there were six pelvic failures (12.5%) all combined with distant metastases and two distant metastases alone. In the 16 patients with Stage IIA treated with radiotherapy alone, there were four pelvic failures (all parametrial), three of them combined with distant metastasis. In the 14 patients treated with irradiation and surgery, two developed a pelvic recurrence, and one distant metastasis. In the preoperative radiation group, the incidence of metastatic pelvic lymph nodes was 6.3% in Stage IB and 7.1% in Stage IIA. Major complications of therapy in the patients treated with radiation alone (10%) consisted of one rectovaginal fistula, two vesicovaginal fistulas, and one rectal stricture. In the preoperative radiation group, three ureteral strictures and two severe proctitis-rectal strictures were noted (8%). The present study shows no significant difference in therapeutic results or morbidity for invasive carcinoma of the uterine cervix Stage IB or IIA treated with irradiation alone or combined with a radical hysterectomy and lymphadenectomy.     

Concurrent radiation and chemotherapy for carcinoma of the cervix recurrent after radical surgery

Results of salvage therapy in patients with carcinoma of the cervix, recurrent after primary surgery, have been dismal even when disease was apparently confined to the pelvis. Further surgery or radiation therapy cured only some with central pelvic disease alone who had recurred at intervals longer than 6 months after primary therapy. To try to improve the results of salvage therapy, we used a combination of concurrent chemotherapy, 5-Fluorouracil with or without Mitomycin-C, and radiation therapy. Seventeen patients were treated. Recurrent disease was present in the pelvis or pelvis and paraaortic nodes after radical surgery for Stage IB carcinoma of the cervix. Eight of seventeen (47%) are alive, disease-free, 21 to 58 months after therapy. Seven of the eight had biopsy proven recurrence. Five of eight had recurred within 9 months of primary surgery and 7/8 had a component of pelvic side wall disease. Thus the survivors had unfavorable prognostic features. Nevertheless, the use of concurrent radiation and chemotherapy produced an exceptionally high proportion of sustained complete remissions and possible cures.     

Optimal therapy for pelvic recurrence after radical hysterectomy for early-stage cervical cancer

Forty-eight patients with pelvic recurrence after radical hysterectomy were evaluated. The influence of location of pelvic recurrence (sidewall versus central), histological grade, histological type, and interval from hysterectomy to recurrence had no influence upon curability by radiotherapy. Ten of twenty-eight patients treated by primary radiation therapy for recurrent disease remain without evidence of disease a minimum of 12 months post-therapy, with a projected 5-year disease-free survival in excess of 30%. No patient treated with adjuvant radiation after initial surgery was rendered disease free by subsequent treatment with radiotherapy. Eleven patients were explored for exenterative surgery. Three of six in whom exenteration was technically feasible remain alive without evidence of disease. None of 15 patients treated with chemotherapy remain free of disease. Radiation therapy remains the treatment of choice in post-radical hysterectomy recurrences confined to the pelvis. As exenterative therapy will result in the cure of a small number of patients with disease confined to the pelvis, exenteration should be considered in patients treated previously by radiotherapy. If these efforts fail, chemotherapy is unlikely to result in cure.     

The role of radical parametrectomy in the treatment of occult cervical carcinoma after extrafascial hysterectomy

OBJECTIVES: To assess the morbidity and efficacy of radical parametrectomy (RP) performed following extrafascial hysterectomy in patients with occult cervical carcinoma. METHODS: An IRB approved retrospective chart review identified 23 patients that underwent RP with pelvic and/or para-aortic lymphadenectomy and upper vaginectomy. Data were collected on demographics, tumor stage, grade, histology, indication for hysterectomy, surgical findings, complications, recurrence, and survival. RESULTS: Of the 23 patients, 2 patients had a stage IA(2) lesion while 21 patients had a stage IB(1) lesion. There were 5 patients with a grade 1 tumor, 10 with grade 2, 4 with grade 3, and 4 with unknown grade. Median age was 41 years (range 27-59). The most common indication (48%) for extrafascial hysterectomy was CIS of the cervix. Four patients (17%) had metastasis to pelvic nodes or evidence of tumor at the margin at the time of RP. Three of these 4 patients with a positive specimen received adjuvant radiation and all are alive (mean follow-up 66 months). One patient declined radiation and is alive at 42 months. There were 7 (30%) operative complications: Most notably 4 patients received blood transfusions. Two of 19 patients (11%) with no residual tumor in RP specimen recurred and 1 patient was salvaged with radiation (follow-up 103 months). With a median follow-up of 61 months (range 9-103), overall 5-year survival is 96%. CONCLUSIONS: RP is an acceptable option for patients diagnosed with an occult cervical carcinoma at the time of extrafascial hysterectomy. Careful selection of RP for patients unlikely to have residual tumor will obviate the need for radiation in most instances.     

Early stage I adenocarcinoma of the uterine cervix: treatment results in patients with tumors less than or equal to 4 cm in diameter

Between 1965 and 1985, 160 patients had initial treatment at the M. D. Anderson Cancer Center for Stage I adenocarcinoma of the uterine cervix less than or equal to 4 cm in diameter. Of these patients, 84 were treated with radiation therapy (RT) alone, 20 were treated with external and intracavitary radiation followed by total hysterectomy (R + S), and 56 were treated with radical hysterectomy (RH). Survival rate was strongly correlated with tumor volume (P = 0.0008), lymphangiogram findings (P = 0.01), and tumor grade (P = 0.0018). Patients with a normal-appearing cervix or a small visible or palpable tumor that did not expand the cervix more than 3 cm had survival and pelvic-control rates of more than 90% after treatment with RH or RT. However, after 5 years, 45% of patients treated with RH for tumors 3-4 cm in diameter had disease recurrence in the pelvis, compared with 11% of patients treated with either RT or R + S (P = 0.025). For patients treated with RH, recurrence was also strongly correlated with findings of lymph/vascular space invasion (P = 0.0004) and poorly differentiated tumor (P = 0.018). Major complication rates were comparable for the three treatment groups. The high rate of pelvic recurrence following treatment with radical hysterectomy alone for patients with tumors greater than 3 cm in diameter, particularly in the presence of lymph/vascular space invasion, poorly differentiated features, and/or positive nodes, should be considered in planning the primary management of patients with Stage I adenocarcinoma of the cervix.     

Patterns of recurrence following hysterectomy and radiation for cervical carcinoma: relationship to residual disease and brachytherapy techniques

Conventional postoperative irradiation following hysterectomy for cervical carcinoma has consisted of external pelvic with or without intra-cavitary vaginal irradiation. In the presence of macroscopically positive margins after initial hysterectomy or in the subsequent context of a central recurrence, such techniques may not be optimum as manifested by the significant rate of local recurrence following conventional irradiation in these settings. The purpose of the retrospective review was to: (a) evaluate pelvic recurrence patterns following initial hysterectomy and radiation in relationship to margin status and brachytherapy techniques in 24 group 1 patients; and (b) evaluate pelvic recurrence patterns in 10 group 2 patients with recurrent disease in relationship to the bulk of residuum after salvage external beam and the brachytherapy techniques used to address this disease. The use of interstitial implantation in select patients with macroscopically positive margins after hysterectomy or persistent central pelvic disease after salvage external beam irradiation is proposed.     

The role of laparoscopic lymphadenectomy in the management of cervical carcinoma.

Laparoscopic lymphadenectomy was performed on 18 patients with invasive carcinoma of the cervix prior to definitive radiation therapy and/or radical hysterectomy. Ten patients underwent pelvic and para-aortic lymphadenectomies prior to planned radiotherapy. Two of these patients had grossly positive pelvic nodes, and one had a microscopically positive para-aortic node. Eight patients with early disease were considered candidates for radical hysterectomy and underwent laparoscopic lymphadenectomy. Three of these patients were found to have positive pelvic lymph nodes and the hysterectomy was abandoned. Five patients underwent radical hysterectomies immediately following their laparoscopic procedures. The average number of lymph nodes removed laparoscopically in these patients was 31.4; the average number of additional lymph nodes resected at laparotomy with the radical hysterectomy was 2.8. A single microscopically positive parametrial lymph node was found on permanent section in 1 patient with radical hysterectomy. No significant complications were associated with the laparoscopic lymphadenectomies. Nine of the 13 patients who underwent laparoscopic procedures only were discharged on Postoperative Day 1. The ability to perform pelvic and para-aortic lymphadenectomy allows for complete surgical staging of carcinoma of the cervix laparoscopically.     

Complications in patients receiving both irradiation and radical hysterectomy for carcinoma of the uterine cervix

One hundred and two patients with invasive carcinoma of the uterine cervix, stages IB, IIA, and selected IA and IIB, were treated using combined radiation therapy and radical hysterectomy. Of these, 88 received approximately 2000 rad of pelvic external radiation and a single 5000-6000 mgh intracavitary implant. Major complications were observed in 5 patients. These resolved spontaneously in 1, and were surgically managed in satisfactory manner in the other 4. Only two of the complications occurred in patients receiving low dose preoperative irradiation. The likelihood of complications was closely related to the radiation dosage. Preoperative radiation prior to radical hysterectomy can be given safely provided that dosimetric principles are observed, and that the radiation and surgical techniques are integrated closely.     

Recurrent cervical carcinoma after radical hysterectomy

The characteristics of recurrent carcinoma following radical hysterectomy and pelvic lymphadenectomy for cervical carcinoma are not well known. Disease recurrence was noted in 27 of 249 patients (11%) with stage IB cervical carcinoma who were treated with a primary surgical approach between January 1962 and December 1984. Fourteen recurrences (52%) occurred within 1 year of surgery, and 24 (89%) within 2 years. Patients with pelvic node metastases or adenocarcinoma had a significantly higher recurrence rate than did patients with negative nodes (33% vs 8%) or with squamous carcinoma (22% vs 8%). Seventeen patients (63%) had disease recurrence in the pelvis or vulva and 12 of these patients had recurrences within 1 year. Eight patients developed asymptomatic pelvic or vulvar recurrences, and all were diagnosed within 1 year. Ten patients (37%) developed recurrences outside the pelvis and 8 of these experienced recurrence after 1 year. Successful treatment after recurrence was independent of clinical or histopathologic parameters except site of recurrence. Eight of 15 patients (53%) who were treated with irradiation for a recurrence in the pelvis or vulva are free of disease 10 to 126 months (median, 48 months) after recurrence. Since irradiation can aid in salvaging patients with recurrent cervical carcinoma confined to the pelvis following radical surgery, clinical vigilance for this site of recurrence is emphasized.     

Recurrent cervical carcinoma after radical hysterectomy: an analysis of clinical aspects and prognosis

Samlal RAK, van der Velden J, van Eerden T, Schilthuis MS, Gonzalez Gonzalez D, Lammes FB. Recurrent cervical carcinoma after radical hysterectomy: an analysis of clinical aspects and prognosis. Int J Gynecol Cancer 1998; 8: 78–84.
The purpose of the present study was to evaluate the clinical aspects and prognosis of patients with tumor recurrence in surgically treated stage IB and IIA cervical carcinoma patients. Two hundred and seventy-one stage IB and IIA cervical carcinoma patients underwent a Wertheim Okabayashi radical hysterectomy with pelvic lymphadenectomy. The median follow-up time was 60 months. Recurrence occurred in 27 patients (10%): 14 had a pelvic recurrence and 13, and extrapelvic recurrence. The site of recurrence was influenced by various pathological factors as well as by the primary treatment mode. 77% of recurrences were detected within three years after primary treatment. The median recurrence-free interval in patients with a pelvic recurrence was significantly shorter than in patients with an extrapelvic recurrence (14 months vs. 17 months, P = 0.03). The mortality rate of the group of patients with recurrent disease was 85% (23/27). Patients with a pelvic central recurrence had a significantly better outcome than did patients whose recurrences were located at the pelvic sidewall. Two patients with a pulmonary recurrence were treated with surgery and show no evidence of disease after 4 and 8 years respectively, of follow-up. The overall detection rate of recurrent disease by routine follow-up was only 36%. However, asymptomatic patients had a significantly better prognosis when compared with symptomatic patients. Therefore, we recommend frequent follow-up visits during the first 3 years after primary treatment to detect recurrence in an early stage.     

Survival of women with surgical stage II endometrial cancer.

OBJECTIVE: The aim of this study was to report survival and determine prognostic factors and results of therapy in women with surgical stage II endometrial cancer. METHODS: Forty-eight consecutive women with surgical stage II endometrial cancer treated at the University of Vermont between March 1984 and March 1998 were reviewed. Patients' characteristics, surgical procedure, postoperative treatment and its complications, and tumor recurrence and its treatment were recorded. In addition, a formal review of their pathological material for confirmation of the diagnosis was performed. RESULTS: The median duration of follow-up was 6.2 years. Three patients (6.3%) had tumor recurrence and two (4.2%) died of their disease. The estimated 5-year overall survival and disease-free survivals were 92.1% (SE = 5.5%, 95% confidence interval: 81.3, 100%) and 89.9% (SE = 5.8%, 95% confidence interval: 78.5%, 100%), respectively. None of the patients treated by total abdominal hysterectomy followed by both whole pelvic and vaginal cuff radiation therapy (the main line of treatment for patients in whom cervical involvement was diagnosed following hysterectomy, n = 20) or by radical hysterectomy (the main line of treatment for patients in whom cervical involvement was known before hysterectomy, n = 11) had tumor recurrence. Three of 17 (17.6%) patients treated with total abdominal hysterectomy followed by either whole pelvic (n = 13) or vaginal cuff (n = 4) radiation therapy had tumor recurrence. The difference between those two groups was statistically significant (0/31 versus 3/17, P = 0.02). There was no difference in survival among women with stage IIA and IIB or women who underwent radical abdominal hysterectomy and those who underwent total abdominal hysterectomy with postoperative pelvic and vaginal cuff radiation. Morbidity secondary to therapy was mild. Age, depth of myometrial invasion, tumor histology, and grade were not significantly related to recurrence. CONCLUSIONS: Survival of women with surgical stage II endometrial cancer is excellent especially among those treated with total abdominal hysterectomy followed by both pelvic and vaginal cuff radiotherapy or by radical abdominal hysterectomy.     

Early stage I adenocarcinoma of the uterine cervix: Treatment results in patients with tumors 4 cm in diameter

Between 1965 and 1985, 160 patients had initial treatment at the M. D. Anderson Cancer Center for Stage I adenocarcinoma of the uterine cervix 4 cm in diameter. Of these patients, 84 were treated with radiation therapy (RT) alone, 20 were treated with external and intracavitary radiation followed by total hysterectomy (R + S), and 56 were treated with radical hysterectomy (RH). Survival rate was strongly correlated with tumor volume (P = 0.0008), lymphangiogram findings (P = 0.01), and tumor grade (P = 0.0018). Patients with a normal-appearing cervix or a small visible or palpable tumor that did not expand the cervix more than 3 cm had survival and pelvic-control rates of more than 90% after treatment with RH or RT. However, after 5 years, 45% of patients treated with RH for tumors 3–4 cm in diameter had disease recurrence in the pelvis, compared with 11% of patients treated with either RT or R + S (P = 0.025). For patients treated with RH, recurrence was also strongly correlated with findings of lymph/vascular space invasion (P = 0.0004) and poorly differentiated tumor (P = 0.018). Major complication rates were comparable for the three treatment groups. The high rate of pelvic recurrence following treatment with radical hysterectomy alone for patients with tumors >3 cm in diameter, particularly in the presence of lymph/vascular space invasion, poorly differentiated features, and/or positive nodes, should be considered in planning the primary management of patients with Stage I adenocarcinoma of the cervix.     

Early stage cervical cancer with negative pelvic lymph nodes: pattern of failure and complication following radical hysterectomy and adjuvant radiotherapy

PURPOSE OF INVESTIGATION: The objective was to optimize the adjuvant treatment for patients with lymph node negative cervical cancer by analyzing patterns of failure and complications following radical hysterectomy and adjuvant radiotherapy. METHODS: From September 1992 to December 1998, 67 patients with lymph node negative uterine cervical cancer (FIGO stage distribution: 50 Ib. 17 IIa), who had undergone radical hysterectomy and postoperative adjuvant radiotherapy with a minimum of three years of follow-up were evaluated. All patients received 50-58 Gy of external radiation to the lower pelvis followed by two sessions of intravaginal brachytherapy with a prescribed dose of 7.5 Gy to the vaginal mucosa. For 21 patients with lymphovascular invasion, the initial irradiation field included the whole pelvis for 44 Gy. The data were analyzed for actuarial survival (AS), pelvic relapse-free survival (PRFS), distant metastasis-free survival (DMFS), and treatment-related complications. Multivariate analysis was performed to assess the prognostic factors. RESULTS: The respective five-year AS, PRFS, and DMFS for the 67 patients were 79%, 93% and 87%. Multivariate analysis identified two prognostic factors for AS: bulky tumor vs non-bulky tumor (p = 0.003), positive resection margin (p = 0.03). The independent prognostic factors for DMFS was bulky tumor (p = 0.003), while lymphatic permeation showed marginal impact to DMFS (p = 0.08). The incidence of RTOG grade 1-4 rectal and non-rectal gastrointestinal complication rates were 20.9% and 19.4%, respectively. The independent prognostic factor for gastrointestinal complication was age over 60 years (p = 0.047, relative risk 4.1, 95% CI 1.2 approximately 11.7). The incidence of non-rectal gastrointestinal injury for the patients receiving whole pelvic radiation and lower pelvic radiation was 28.5% and 15.2%, respectively (p = 0.25). CONCLUSION: For patients with lymph node negative cervical cancer following radical hysterectomy, adjuvant lower pelvic radiation appears to be effective for pelvic control. It is also imperative to intensify the strategies of adjuvant therapy for some subgroups of patients.     

Radical hysterectomy and pelvic lymph node dissection

Twenty-five years' experience with radical hysterectomy and pelvic lymph node dissection in early carcinoma of the cervix is presented. The results indicate that younger patient ovarian salvage was successful. The patients with postoperative positive pelvic nodes were treated by external radiation therapy. Urinary tract complications of atonic bladder have presented a problem that has not been solved. The indications for operation continue to increase and, we feel, will continue to increase in the future because of the early diagnosis of cervical cancer and a greater number of patients that fit this category.     

Central pelvic recurrence 7 years after radical vaginal trachelectomy

BACKGROUND: We report a case of central pelvic recurrence 7 years after radical vaginal trachelectomy for adenocarcinoma of the cervix. CASE: A 30-year-old woman was treated by radical vaginal trachelectomy and bilateral pelvic lymph node dissection (a fertility sparing procedure) in 1996 for cervical cancer. Pathology demonstrated a well differentiated, stage 1B1 adenocarcinoma. She presented 7 years later with a central pelvic recurrence measuring 30 mm in width. She subsequently underwent radical hysterectomy for central clearance and did not require post-operative radiotherapy. CONCLUSIONS: Should selected patients who were initially treated by radical trachelectomy for early stage cervical cancer, in particular those with adenocarcinoma (as 50% of recurrences have been reported in this group of patients), be offered hysterectomy once child bearing is complete?     

Laparoscopic radical hysterectomy for invasive cervical cancer: 8-year experience of a pilot study

OBJECTIVE: The aim of this study was to retrospectively evaluate, in a series of 50 consecutive patients, the feasibility, morbidity, and survival outcome of the laparoscopic radical hysterectomy for carcinoma of the uterine cervix. METHODS: Fifty patients with invasive cervical cancer were operated on by laparoscopic radical hysterectomy between 1993 and 2001 at two cancer centers. Patients in a good general condition with a cervical carcinoma less than 4 cm and a body mass index up to 29 were eligible. Thirty-one patients had prior brachytherapy. RESULTS: The median overall operative time was 258 min. The mean number of harvested pelvic external iliac nodes was 13.22 per patient. The median postoperative hospital stay was 7.5 days. Two patients had major urinary complications; one had a bladder fistula and one a ureteral stenosis. The median follow-up was 44 months. The overall 5-year survival rate of FIGO stage Ia2 and Ib1 patients was 96%. CONCLUSION: Our results demonstrate that radical hysterectomy can be performed by laparoscopy in stage IB1 or less advanced node negative cervical cancer patients without compromising survival. Prior brachytherapy did not affect the feasibility of this radical procedure.     

Total pelvic exenteration as a therapeutic option in advanced malignant disease of the pelvis

Between 1966 and 1986, 99 patients underwent total pelvic exenteration at the Ellis Fischel State Cancer Center. Fifty-eight per cent of these were done for recurrence of carcinoma of the cervix uteri after radiation. The second most common type of malignant condition treated with total pelvic exenteration was localized advanced adenocarcinoma of the rectum. Fourteen of 99 patients died prior to discharge and after five years, 36 of 80 patients had survived. Seven deaths after discharge were attributed to the operation. There were 97 complications in 64 of the 99 patients after total pelvic exenteration prior to discharge. Between 1976 and 1981, one out of 14 patients undergoing total pelvic exenteration for locally advanced recurrent carcinoma of the cervix uteri died prior to discharge. Eight of 13 of the patients who survived that operation lived for five years. Total pelvic exenteration should be strongly considered in selected patients with locally advanced malignant lesions of the pelvis.     

Role of centralization of surgery in Stage IB carcinoma of the cervix: a review of 498 cases

A review was undertaken of 498 patients with stage IB carcinoma of the cervix managed over a 15-year period in the Regional Gynaecological Oncology Centre, Gateshead. All but 4 were treated by radical hysterectomy, with adjuvant radiotherapy and/or chemotherapy for those with involved pelvic nodes. The overall 5-year survival in those with negative nodes was 91.4% compared with 50.5% in those with positive nodes (P less than 0.05). Of those dying from the disease, 7 patients only (1.4%) developed central recurrence, the remainder experiencing pelvic side-wall or distant recurrence. There was no difference in survival related to patient age. There were three deaths related to surgery and a fistula rate of only 1.2%. Bladder hypotonia and lymphocyst affected a minority of patients in the long term. The data support the case for radical surgery in stage IB carcinoma of the cervix, managed on a centralized referral basis.     

Can a lymphadenectomy be avoided in early-stage endometrial adenocarcinoma?

Purpose

Determination of early disease recurrence in patients with early-stage endometrial cancer operated laparoscopically without pelvic or paraaortic lymphadenectomy.

Methods

Retrospective chart review of all patients with endometrial carcinoma operated with laparoscopic-assisted vaginal hysterectomy with bilateral salpingo-oophorectomy between 2004 and 2008.

Results

81 patients were eligible for data analysis. The operation time varied between 32 and 284 min. None of the patients suffered serious intraoperative complications. All patients had endometrial carcinoma of endometrioid type. As adjuvant therapy, patients received no further therapy (n = 30), radiation with brachytherapy with an afterloading technique alone (n = 36) or brachytherapy in combination with percutaneous radiation (n = 15). The observation period varied between 19 and 28 months (median 26 months). No patients were lost to follow-up. During the observation period, none of the patients had recurrence of disease or died.

Conclusions

Laparoscopic-assisted vaginal hysterectomy with bilateral salpingo-oophorectomy without pelvic or paraaortic lymphadenectomy combined with stage-adapted postoperative irradiation is a safe and efficient treatment option for patients with early-stage endometrial cancer of the endometriod type regarding early disease recurrence.     

子宫颈小细胞癌的临床及病理分析

目的 探讨子宫颈小细胞癌的临床病理特征诊断和治疗。方法 回顾性分析８例子宫颈小细胞癌的临床记录和随访资料。结果 ８例均表现为不同程度的阴道排液增多,病理学特点为大小形态一致的圆形或短梭形小细胞,弥漫性浸润间质,符事宫颈小细胞癌的病理学诊断;２例神经元特异性烯醇化酶免疫组织化学染色阳性,８例中,Ｉｂ期５例,Ⅱｂ期３例,７例接受了广泛子宫切除及盆腔淋巴结清扫描术治疗,１例Ⅱｂ期患者仅接受了放射治疗。２