同步放化疗治疗中晚期宫颈癌50例临床疗效观察

目的:探讨同步放化疗治疗中晚期宫颈癌的疗效及毒副反应。方法:选择宫颈癌患者100例,随机分为2组,单纯放疗组50例,同步放化疗组50例。两组放疗方法相同,同步放化疗组于放疗前、中及放疗结束后给予CTB(卡铂加吡柔比星加博来霉素)腹壁下动脉灌注化疗,每周期间隔28天,共化疗3周期。比较两组病例近期、远期疗效及毒副反应。结果:同步放化疗组与单纯放疗组近期有效率分别为96%、72%,(P<0.05),同步放化疗组与单纯放疗组的5年生存率分别为64%、44%,(P<0.05),同步放化疗组骨髓抑制及消化道反应发生率均高于单纯放疗组(P<0.05),及时对症治疗后,患者均可耐受治疗。结论:同步放化疗治疗中晚期宫颈癌可提高近期疗效及5年生存率。以铂类为基础的化疗疗效肯定,患者能耐受,与放疗联合应用安全、合理。     

宫颈癌同步放化疗临床应用进展

同步放化疗是目前宫颈癌治疗的新进展，小剂量的化疗药物对放疗起到增敏的作用。就同步放化疗的机制、化疗方式、疗效及毒副反应进行综述。机制大致可概括为化疗抑制肿瘤细胞放疗后损伤的修复．减少对放疗不敏感的乏氧细胞的比例和促使肿瘤细胞同步化进入对放疗敏感的细胞周期。同步放化疗对宫颈癌的治疗效果优于单纯放疗，可提高宫颈癌患者的总生存率和无进展生存率。降低复发率，改善预后，增加手术机会和减少术中及术后并发症。由于化疗药物剂量小，故毒副反应不重，大多数患者可耐受。认为使用以顺铂为基础的同步放化疗方案效果更佳。其具体使用方法仍处于摸索阶段。     

宫颈癌同步放化疗临床应用进展

同步放化疗是目前宫颈癌治疗的新进展,小剂量的化疗药物对放疗起到增敏的作用.就同步放化疗的机制、化疗方式、疗效及毒副反应进行综述.机制大致可概括为化疗抑制肿瘤细胞放疗后损伤的修复,减少对放疗不敏感的乏氧细胞的比例和促使肿瘤细胞同步化进入对放疗敏感的细胞周期.同步放化疗对宫颈癌的治疗效果优于单纯放疗,可提高宫颈癌患者的总生存率和无进展生存率,降低复发率,改善预后,增加手术机会和减少术中及术后并发症.由于化疗药物剂量小,故毒副反应不重,大多数患者可耐受.认为使用以顺铂为基础的同步放化疗方案效果更佳.其具体使用方法仍处于摸索阶段.     

3种方案同步放化疗治疗中晚期宫颈癌的疗效对比观察

目的:探讨治疗中晚期宫颈癌同步放化疗的化疗方案选择.方法:96例中晚期宫颈癌患者同步放化疗随机分成顺铂组(30例)、多西紫杉醇组(34例)及顺铂联合多西紫杉醇组(32例),观察3组的治疗效果和副反应,并进行比较.结果:外照射结束时3组的有效率分别为96.67%、100%及100%,差异无统计学意义(P＞0.05);顺铂组的4年生存率、局部复发率、远处转移率与另两组比较,差异有统计学意义(P＜0.05);多西紫杉醇组与顺铂联合多西紫杉醇组差异无统计学意义(P＞0.05);顺铂组及顺铂联合多西紫杉醇组有较明显的骨髓抑制和消化道反应,而且肾功损害明显,与多西紫杉醇组比较差异有统计学意义(P＜0.05).结论:多西紫杉醇单药同步放化疗与顺铂单药及两药联合同步放化疗比较,能明显提高患者的生存率,降低局部复发率及远处转移率,同时副反应相对较轻.     

紫杉醇脂质体联合卡铂同步放化疗治疗中晚期宫颈癌的疗效观察

目的 研究中晚期宫颈癌患者采用紫杉醇脂质体联合卡铂方案同步放化疗的临床治疗效果。方法 选取30例中晚期宫颈癌患者作为研究对象,按照随机数字表法分为试验组与对照组,每组15例。对照组应用紫杉醇联合卡铂方案同步放化疗,试验组应用紫杉醇脂质体联合卡铂方案同步放化疗。观察比较两组患者治疗3个月后的临床效果,治疗6个月后的肿瘤复发情况、无瘤生存情况,以及治疗后毒副反应发生情况。结果 试验组患者治疗3个月后的临床有效率为93.33%,明显高于对照组的60.00%,差异有统计学意义（P<0.05）。试验组患者治疗6个月肿瘤复发率为6.67%,明显低于对照组的40.00%,无瘤生存率（66.67%）明显高于对照组的26.67%,差异均有统计学意义（P<0.05）。试验组患者的毒副反应发生率为53.33%,与对照组的46.67%比较,差异无统计学意义（P>0.05）。结论 对于中晚期宫颈癌患者应用紫杉醇脂质体联合卡铂方案同步放化疗,可以显著提升患者的临床疗效和无瘤生存率,降低肿瘤复发率,且不良反应可耐受,临床应用价值较高。     

局部晚期宫颈癌同步放化疗后巩固化疗的疗效分析

目的 探讨局部晚期官颈癌同步放化疗后巩固化疗的疗效和毒副作用.方法 将福州军区总医院2006年1月至2007年3月收治的78例局部晚期宫颈癌同步放化疗的患者随机分为巩固化疗组(40例)和观察组(38例),对比其3年生存率和毒副反应.结果 巩固化疗组和观察组相比,3年生存率(87.5%和84.2%)和无进展生存率(80....     

同步放化疗——宫颈癌治疗的新模式

随着近年一些大规模随机对照研究的问世,以顺铂为基础的同步放化疗在治疗局部晚期宫颈癌及早期高危宫颈癌中取得突破性进展。这些研究总例数超过2000例,病理类型包括鳞癌、腺癌及腺鳞癌。用这种模式治疗不仅提高了肿瘤局部控制率,而且降低了远处转移率,明显改善了宫颈癌生存率。使得复发和死亡的相对危险度分别下降了50％和40％。同步放化疗的血液学毒性和胃肠道毒性较单纯放疗高,但绝大多数是可逆的。远期并发症两者相似。同步放化疗有可能成为宫颈癌治疗的一种新的标准模式。     

106例局部晚期宫颈癌根治性同步放化疗的临床疗效及预后影响因素

目的:分析无髂总淋巴结和腹主动脉旁淋巴结转移局部晚期宫颈癌患者根治性同步放化疗临床疗效、放疗毒性反应,探讨预后影响因素。方法:回顾分析2018年1月至2020年8月川北医学院附属医院肿瘤科放疗中心行根治性同步放化疗的106例局部晚期宫颈癌患者的临床资料,其中43例采用常规全盆腔放疗(PRT),63例采用盆腔延伸野放疗(EFRT)。通过实体瘤疗效评价标准评估近期疗效,用总生存期(OS)、无进展生存期(PFS)评估远期疗效。通过单因素和多因素分析影响预后的因素。依据肿瘤放射治疗协作组放射损伤分级标准评估放疗毒性反应。结果:106例患者客观缓解率为77.4%,疾病控制率为93.4%。1、3年OS率分别为95.2%、78.5%,1、3年PFS率分别为85.1%、68.1%。多因素分析显示,PRT是局部晚期宫颈癌患者OS(HR=3.78,95%CI为1.21～11.87,P=0.023)和PFS(HR=3.13,95%CI为1.302～8.428,P=0.012)的独立危险因素;盆腔淋巴结转移数目(<3枚和≥3枚)、近期疗效是影响OS的独立预后因素(P<0.05)。年龄、近期疗效是影...     

同步放化疗—宫颈癌治疗的新模式

随着近年一些大规模随机对照研究的问世，以顺铂为基础的同步放化疗在治疗局部晚期宫颈癌及早期高危宫颈癌中取得突破性进展。这些研究总例数超过2000例，病理类型包括鳞癌、腺癌及腺磷癌。用这种模式治疗不仅提高了肿瘤局部控制率，而且降低了远处转移率，明显改善了宫颈癌生存率。使得复发和死亡的相对危险度分别下降了50%和40%。同步放化疗的血液学毒性和胃肠道毒性较单纯放疗高，但绝大多数是可逆的。远期并发症两者相似。同步放化疗有可能成为宫颈癌治疗的一种新的标准模式。     

59例宫颈癌术前同步放化疗的疗效观察

目的:观察59例宫颈癌患者手术前同步放化疗的疗效和毒副作用。方法:59例宫颈癌病人分成两组:同步放化疗组(33例)和单纯放疗组(26例)。同步放化疗组采取放疗的同时静脉滴注化疗药物顺铂,剂量30mg/m2/周。单纯放疗组仅仅进行单纯放疗治疗。结果:同步放化疗组近期疗效有效率为96.97%,单纯放疗组为76.92%,两组间有效率比较有统计学意义(P<0.05);同步放化疗组主要不良反应是消化道反应,骨髓抑制也较为常见。同步放化疗组胃肠道反应发生率为78.8%,骨髓抑制率为48.5%,单纯放疗组两项指标分别为50.0%、30.8%,两者间均存在统计学意义;术前同步放化疗并不增加并发症,两组间并发症发生情况并无统计学意义(P>0.05)。结论:宫颈癌患者手术前同步放化疗比单纯放疗组具有更高的效率和更低的毒副作用,且两者之间的并发症发生情况并无不同。     

Intensity-modulated radiation therapy for advanced cervical cancer: a comparison of dosimetric and clinical outcomes with conventional radiotherapy

Objective

The aim of this study is to evaluate the dosimetry, efficacy and toxicity of reduced field intensity-modulated radiation therapy (RF-IMRT) for patients with advanced cervical cancer.

Methods

From August 2005 to August 2010, 60 patients with stage IIB-IIIB cervical cancer underwent reduced field IMRT (RF-IMRT group) and 62 patients treated with conventional radiotherapy (c-RT group) were enrolled. The RF-IMRT plans were as follows: whole pelvic IMRT plan was performed to deliver a dose of 30 Gy firstly, then the irradiated volume was reduced to lymphatic drainage region as well as paracervix and parametrium for an additional 30 Gy boost. Intracavitary brachytherapy and concurrent chemotherapy were performed during external irradiation. The tumor coverage and normal tissue avoidance were evaluated. Treatment response, toxicities and survival were assessed.

Results

The mean dose delivered to the planning target volume was significantly higher in RF-IMRT group than in c-RT group (61.5 vs. 50.8 Gy, P = 0.046). IMRT plans yielded better dose conformity to the target and better sparing of the rectal, bladder and small intestine. The RF-IMRT patients experienced significantly lower acute and chronic toxicities with comparable short-term effects than did those treated with conventional RT (CR: 87.7% vs. 88.3%, P = 0.496; PR: 7.0% vs. 6.7%, P = 0.440). No significant differences were found between treatment groups for 1 year, 3 year, and 5 year overall survival (OS) levels, although the latter approached statistical significance in favor of IMRT, while a significantly higher progression-free survival (PFS; P = 0.031) was seen for IMRT.

Conclusions

RF-IMRT yields improved dose distributions, with lower toxicities, while providing comparable clinical outcomes. The increased PFS may be an advantage.     

The pathology of cervical cancer

The preinvasive phase of squamous cell carcinoma of the cervix is a continuous spectrum of abnormal epithelium, which, for convenience of classification and as a guide to management, is customarily subdivided into three grades. The histological diagnosis of CIN, as well as the distinction between the grades, depends on a combination of features embracing aspects of differentiation, nuclear changes and mitotic activity. Grading of CIN is subjective. Generally, a minor degree of CIN would be expected to progress to a more severe form if not treated, but this progression does not seem to be inevitable; the more severe a CIN is at the time of diagnosis, the more likely it is that it will progress, both to a more severe degree of CIN and, eventually, to invasive carcinoma. Conversely, the more minor the degree of CIN at diagnosis, the more likely it is that it will regress. True figures are not available for the rate of progression from CIN to invasive carcinoma; it is sufficient to accept that the risk of progression probably occurs in a significant proportion of cases, if not the majority. Preclinical invasive carcinoma is divided into microinvasive carcinoma and occult invasive (Stage Ib) carcinoma. The definitions of these lesions have not yet been satisfactorily established; the term microinvasive carcinoma should define the maximum size of tumour which has virtually no metastatic potential and so may be treated in a conservative fashion. Invasive squamous cell carcinoma is classified histologically according to the cell type and the degree of differentiation, although it is debatable whether the cell type has any correlation with prognosis. Adenocarcinomas make up 5-10% of cervical cancers and a variety of histological types have been recognized. Adenocarcinoma in situ is being diagnosed with increasing frequency, often in association with squamous CIN. It seems apparent that AIS is a precursor of adenocarcinoma, but little is known about its natural history.     

Impact of facility volume on therapy and survival for locally advanced cervical cancer

Objective

Chemosensitizing radiation with brachytherapy is standard of care for treatment of locally advanced cervical cancer, an increasingly rare disease. Treatment facility volume has been correlated with outcome in many diseases. Treatment outcome and likelihood of receiving standard therapy in locally advanced cervical cancer based on facility volume were examined using a large national cancer database.

Methods

The National Cancer Data Base was queried for patients with stage IIB – IIIB cervical cancer from 1/1998 through 12/2010. Facility volumes were tallied. Overall survival was estimated using Kaplan–Meier method. Univariate and multivariable analyses were performed to determine variables affecting survival, receiving standard therapy, and total duration of radiotherapy.

Results

We identified a total of 27,660 patients who were treated at 1361 facilities. Thirty of the facilities (2.2%) treated the highest quartile volume of patients (> 9.4 patients annually) while 1072 facilities (78.8%) treated < 2.4 patients annually. The median age of patients was 53, the majority were Caucasian, treated in a metropolitan area, and of squamous cell histology. Median survival of patients treated at lowest- and highest-volume centers were 42.3 months (95% CI 39.8–44.8) and 53.8 months (50.1–57.5), respectively (p < 0.001). The proportions of patients receiving brachytherapy and chemotherapy were 54.8% and 79.9%, respectively. On multivariable analysis, higher facility volume independently predicted improved survival (p = 0.022), increased likelihood of receiving brachytherapy (p < 0.0005) and chemotherapy (p = 0.013), and shorter time to radiotherapy completion (p < 0.0005).

Conclusions

Patients with locally advanced cervical cancer treated at high volume centers are more likely to receive standard therapy, complete therapy sooner, and experience better survival.     

Dose-volume effects in pathologic lymph nodes in locally advanced cervical cancer

Objective

In cervical cancer patients, dose-volume relationships have been demonstrated for tumor and organs-at-risk, but not for pathologic nodes. The nodal control probability (NCP) according to dose/volume parameters was investigated.

晚期卵巢癌预后相关因素分析

目的:探讨血糖、临床病理特征与晚期卵巢癌预后的关系。方法:回顾分析天津市中心妇产科医院2003年1月～2008年12月收治并随访到的159例Ⅲ、Ⅳ期上皮性卵巢癌患者的临床资料。采用Kaplan-Meier法分析生存时间,单因素分析各变量与预后的关系用log-rank检验,多因素分析用Cox风险比例回归模型。结果:25例血糖≥6.10mmol/L患者3年(47.96%)及5年(32.57%)生存率低于血糖6.10mmol/L者(P0.05)。Ⅲc期卵巢癌患者的3、5年生存率分别为54.36%和34.51%,Ⅳ期患者的3、5年生存率分别为32.49%和15.92%(P0.05)。组织学分化为G2和G3者3、5年生存率分别为45.89%和31.79%,低于G1者(P0.05)。残余肿瘤直径2cm患者3、5年生存率分别为39.12%和26.76%,低于残余肿瘤直径≤2cm者(P0.05)。浆液性、黏液性、子宫内膜样、未分类4组病理类型患者的远期生存率差异无统计学意义(P0.05)。Cox风险比例回归模型进行多因素分析,血糖高低[相对危险度(RR)为2.008,95%置信区间(CI)为1.179～4.018,P=0.034]、手术病理分期(RR=2.391,95%CI为1.345～4.198,P=0.024),组织学分化(RR=2.363,95%CI为1.351～4.193,P=0.032)及残余肿瘤大小(RR=3.564,95%CI为2.683～6.857,P=0.01)是卵巢癌的预后因素。结论:血糖、手术病理分期、组织学分化、残余肿瘤直径可以作为卵巢癌的预后因素。     

Phase I study of topotecan and radiation therapy in advanced cervical cancer

OBJECTIVE: The goal of this study was to determine the maximal tolerated dose (MTD) of topotecan given with external-beam radiotherapy in advanced cervical cancer. METHODS: A prospective Phase I trial of topotecan given with standard external-beam radiotherapy was performed in patients with advanced squamous cell carcinoma of the cervix. Patients were treated with a starting dose of 0.5 mg/m(2) and escalated by 0.25 mg/m(2). Nine patients were treated. Hematologic and nonhematologic toxicity were measured. RESULTS: Patients were treated with 1.0 mg/m(2) daily for 5 days on Days 1-5 and 22-26 concomitantly with radiotherapy without significant toxicity. Grade III anemia in one case and Grade II leukopenia in two cases were seen in the three patients at this dose level. Dose-limiting toxicity was not reached. CONCLUSION: Topotecan can be safely administered at a dose of 1.0 mg/m(2) during external-beam radiotherapy for advanced cervical cancer.     

Surgical morbidity and oncologic results after concurrent chemoradiation therapy for advanced cervical cancer

Objective

To evaluate the surgical morbidity and oncologic results after concurrent chemoradiotherapy (CCRT) followed by completion surgery for advanced cervical carcinoma.

Methods

The present retrospective analysis included 192 patients with advanced cervical cancer (stage IIB–IVA) treated with CCRT followed by surgery and 186 control patients without completion surgery. Disease-free and overall survival rates were compared.

Results

Of the patients who underwent surgery, 27 (14.1%) had pathologic evidence of residual disease; the local control rate with CCRT was 85.9%. After a median follow-up period of 190 months, 32 (16.7%) patients who underwent completion surgery had a recurrence compared with 59 (31.7%) of those who did not. The overall survival rate among patients who underwent extrafascial hysterectomy, extended hysterectomy, or no surgery was 72.2%, 60.1%, and 45.9% at 3 years, and 53.5%, 40.7%, and 32.2% at 5 years, respectively.

Conclusion

Surgery after CCRT for advanced cervical cancer enabled evaluation of the pathologic response to therapy, improved local disease control in patients with a partial pathologic response, and enhanced survival. The most appropriate surgical approach was extrafascial hysterectomy with pelvic lymph node dissection.