原发性阴道癌44例临床分析

目的 探讨原发性阴道癌临床预后及治疗方法。方法 １６例原发性阴道癌采用放疗加顺铂,５－ＦＵ及丝裂霉素三联全身化疗,单行放疗者２８例。结果 ５年及１０年存活率为５０．９％和３８．１％。Ⅱ期３年及５年存活率为７４．５％和６１．１％,Ⅲ期３年及５年存活率为５６．８％,和４５．１５,Ⅳ期３年及５年存活率为０,Ⅱ期与Ⅲ期３年及５年存活率比较Ｐ〈０．０５。     

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。     

42例原发性阴道恶性肿瘤临床分析

目的 总结原发性阴道恶性肿瘤的l临床特点,探讨原发性阴道恶性肿瘤的治疗方法 及预后因素.方法 同顾性分析1984年1月-2006年8月北京协和医院收治的42例原发性阴道恶性肿瘤患者的临床特点、治疗方法 及预后情况.结果 原发性阴道恶性肿瘤患者占本院同期收治妇科恶性肿瘤患者的0.98%(42/4286).42例患者中,鳞癌13例,黑色素瘤13例,腺癌8例,内胚窦瘤及肉瘤各3例,癌肉瘤及阴道上皮瘤样癌各1例;1期19例,Ⅱ期12例,Ⅲ期5例,Ⅳ期6例.治疗七采用了以手术为主的综合治疗.随诊至2007年8月,有19例患者牛存,死亡18例,失访5例.随诊时间最长为10年,中位随诊时间为2年,总体两年生存率达60.6%.其中,1期患者的两年生存率为71.3%,Ⅱ期为58.3%,Ⅲ～Ⅵ期为29.6%.根据病理类型不同,鳞癌患者的两年生存率为46.8%,黑色素瘤为72.9%,腺癌为20.0%,3例内胚窦瘤患者随诊6～10年全部尤瘤存活.结论 原发性阴道恶性肿瘤的预后与分期、病理类型相关.阴道黑色素瘤患者以手术+化疗+免疫治疗取得了较好的效果,阴道内胚窦瘤患者以单纯化疗效果好.对于其他少见的病理类型,缺乏治疗经验,但基本上仍以手术+化疗为主.     

原发性阴道恶性黑色素瘤25例临床分析

探讨病灶大小和不同治疗后手段对原发性阴道恶性黑色素瘤预后的影响。方法对我院１９６４年１２月至１９９７年１０月,收治的２５例原发性阴道恶性黑色素瘤患者的临床资料进行回顾性分析。结论原发性阴道恶性黑色素瘤预后差,但如早期诊断并采用以手术为主的综合治疗,有可能改善预后。     

原发性阴道癌的放射治疗

原发性阴道癌的治疗方法有单纯放射治疗、手术或手术加放疗、放疗加化疗综合治疗等。治疗方法的选择主要取决于病变部位，病灶大小、期别、各单位医疗条件、医生的经验。原位癌可局部切除或单纯腔内放疗，Ⅰ期和少数Ⅱ期早期可行手术治疗或单纯放疗，Ⅱ期至Ⅳ期行单纯放射治疗或同时性进行放射治疗和化疗。     

52例原发性阴道癌临床分析

Objective?To investigate the clinical features and prognostic factors of primary vaginal cancer. Methods?A total of 52 patients with complete pathological diagnosis and clinical follow-up data were selected from the first Affiliated Hospital of Zhengzhou University from January 2013 to January 2020. The general characteristics, different treatment methods and overall prognosis of the patients were analyzed. Results?the 1-year, 3-year and 5-year survival rates of 52 patients with primary vaginal cancer were 80.7%, 61.1%, and 48.1%, respectively. Among them, 28 patients (53.8%) had squamous cell carcinoma, and the median survival time was 92 months. There were 12 cases of malignant melanoma (23.0%), and the median survival time was 12 months The 5-year survival rates of early stage (stageⅠ+stageⅡ) and late stage (stageⅢ+stageⅣ) were 61.0% and 0.0%, respectively. Univariate analysis showed that FIGO stage, pathological type, tumor size, treatment mode, tumor growth stage and vaginal invasion length were related to the prognosis of patients (P<0.05). COX multivariate regression analysis showed that 2009 FIGO stage (P=0.002) and pathological type (P=0.000) were independent factors affecting the prognosis of patients with primary vaginal cancer.  The prognosis of different pathological types, such as squamous cell carcinoma and malignant melanoma, was significantly different (χ2=17.704, P=0.000). There was statistically significant difference between combined radiotherapy and chemotherapy with radiotherapy or chemotherapy alone (χ2= 4.017, P=0.045). Conclusion?The prognosis of primary vaginal cancer is related to pathological type and clinical stage. The earlier the clinical stage, the better the prognosis. The survival cycle of squamous cell carcinoma is much higher than that of malignant melanoma. The treatment is mainly radiotherapy, and the combined treatment of radiotherapy and chemotherapy is better than radiotherapy or chemotherapy alon.     

阴道肉瘤六例临床分析

总结阴道肉瘤的临床特点及治疗方法,方法对６例阴道肉瘤病例进行回顾性分析,其中平滑肌肉瘤２例,腺泡状软组织肉瘤,血管肉瘤,淋巴瘤及横纹肌肉瘤各１例,结果６例患者的年龄为７－５２岁。结论阴道肉瘤行局部广泛切除术后,应辅以化疗及放疗。     

阴道分娩产后尿潴留51例的临床观察及护理体会

目的：探讨产后尿潴留的临床观察与护理体会。方法：对2008年8月至2011年12月住院产妇阴道分娩发生尿潴留51例产妇的护理进行回顾性分析。结果：通过心理疏导物理刺激及药物治疗,患者均自解小便。结论：细心观察病情,有效的健康指导及护理干预,可以大大减少产后尿潴留的发病机会。     

Concurrent chemoradiotherapy using high-dose-rate intracavitary brachytherapy for uterine cervical cancer

OBJECTIVE: We retrospectively reviewed our experience with concurrent chemoradiotherapy (CCRT) using high-dose-rate intracavitary brachytherapy (HDR-ICBT) to assess its feasibility and efficacy in the treatment of patients with uterine cervical cancer. METHODS: Forty patients with uterine cervical squamous cell carcinoma treated with CCRT using HDR-ICBT were analyzed. The median cervical tumor size assessed by MRI was 63 mm (range: 40-86 mm). Eighteen patients (45%) had enlarged pelvic nodes on MRI (> or =10 mm). Cisplatin (20 mg/m2/day) was concurrently administered with radiotherapy for 5 days at 21-day intervals for a median of three courses (range: 1-5 courses). Thirty-eight (95%) patients received whole pelvic external beam radiotherapy (EBRT) with 40 Gy/20 fractions followed by HDR-ICBT with 18 Gy/3 fractions to point A. Subsequently, additional pelvic EBRT with 10 Gy/5 fractions was delivered with a midline block. The cumulative biological effective dose (BED) at point A of this schedule was 77 Gy10. The median follow-up period for all 40 patients was 37 months (range: 8-71 months). RESULTS: Grade 3/4 leukopenia was the most common acute side effect (83%). The actuarial 3-year pelvic control rate, disease-free survival rate, and overall survival rate were 91%, 67%, and 79%, respectively. Eight (20%) patients suffered late gastrointestinal complications (all grades). No patient suffered radiation cystitis (all grades). Only one patient experienced grade 3 complication (enterocolitis). The actuarial 3-year late complication rate (all grades) was 9% for proctitis and 15% for enterocolitis. CONCLUSION: This preliminary study suggests that CCRT using HDR-ICBT is feasible and efficacious for patients with locoregionally advanced uterine cervical cancer.     

252Cf中子腔内后装加盆腔外照射治疗子宫颈癌临床分析

目的观察^252Cf腔内后装加盆腔外照射治疗宫颈癌的疗效以及晚期并发症的发生情况,并对治疗方案进行总结。方法选择77例未接受过任何治疗的临床分期为Ⅱa～Ⅳa期的宫颈癌患者作为研究对象,其中Ⅱa期13例,Ⅱb期32例,Ⅲa期18例,Ⅲb期10例,Ⅳa期4例。治疗方案：^252Cf中子腔内后装治疗,宫旁A点剂量为8～11Gy／次,1次／周,共进行4～5次,使宫旁A点累积剂量达36～45Gy;该治疗过程中,间歇穿插前后对穿野全盆腔外照射200cGy／次,4次／周;外照射20—36Gy后,盆腔野中央屏蔽挡铅4cm,继续四野外照射200cGy／次,4次／周,使盆腔外照射总剂量达到45～50Gy左右。总疗程约需5—6周。结果77例患者随访3年,3年局部控制率为94％(72／77);3年总生存率为82％(63／77),其中临床分期Ⅱa期为85％(11／13),Ⅱb期为94％(30／32),Ⅲa期为78％(14／18),Ⅲb期为70％(7／10),Ⅳa期为1／4。放射性膀胱炎发生率为3％,放射性直肠炎发生率为5％。结论^252Cf中子腔内后装加盆腔外照射治疗宫颈癌,患者能较好耐受,且其Ⅱ、Ⅲ期患者的3年生存率较高而并发症发生率较低,具有较好的应用前景。     

巨块型宫颈癌术前高剂量率腔内放疗近期疗效分析

目的探讨巨块型宫颈癌根治术前高剂量率腔内近距离放疗(ICBT)的治疗效果。方法对200001-200412中山大学附属肿瘤医院和附属第二医院收治的51例ⅠB2～ⅡB期巨块型宫颈癌根治术前采用ICBT,对患者的局部肿瘤缓解情况、毒副反应、手术情况及高危病理因素进行回顾性分析;与同期直接接受根治术的同期别56例巨块型宫颈癌比较。结果施行ICBT后,宫颈肿瘤临床完全缓解5.9%(3/51),部分缓解51.0%(26/51),无变化43.1%(22/51),恶化0。并发症发生率较低,主要是骨髓抑制、腹泻、放射性直肠炎和膀胱炎。全部患者均按宫颈癌根治术规范完成。ICBT组较直接手术组手术时间缩短(3.58±1.08)h对(4.46±0.93)h,术中出血量减少(395.1±219.8)mL对(999.1±637.4)mL,术后拔尿管时间缩短(11.47±6.48)d对(15.18±8.41)d,尿潴留的发生率减少(37.25%对48.2%)。除尿潴留外,两组比较差异均有显著性(P<0.05)。高危病理差异无显著性(P>0.05)。结论宫颈癌根治术前适当剂量腔内放疗是较早期巨块型宫颈癌较理想的治疗方案。     

Salvage treatment with high-dose-rate brachytherapy for isolated vaginal endometrial cancer recurrence

OBJECTIVE: To evaluate the outcome of patients with recurrent vaginal endometrial cancer treated with high-dose-rate brachytherapy (HDRB) and external beam radiation therapy (EBRT). MATERIALS AND METHODS: The records of all patients diagnosed with endometrial cancer who had presented an isolated vaginal recurrence in our institution between January 1, 1997 and December 30, 2003 were reviewed. Twenty-two patients were identified; 18 (82%) received both EBRT and HDRB, and 4 (18%) received HDRB only. The median EBRT dose prescribed was 45 Gy (range: 44-50.4), and median HDRB was 26 Gy (range: 8-48). Recurrence-free intervals as well as disease-specific survival rates were noted. Complications were assessed in terms of early and late Radiation Therapy Oncology Group toxicity (grade 3 or worse) of the gastrointestinal tract, genitourinary tract and vagina. RESULTS: Median age at recurrence for the 22 patients was 72 years (range: 54-86). Median recurrence time was 20 months (range: 4-135). A complete response was achieved in 100% of patients. After a median follow-up of 32 months (range: 11-78), no patient had locoregional recurrence; 1 developed distant metastasis and died from the disease. Five-year local control, disease-free survival and disease-specific survival were 100%, 96% and 96%, respectively. Four patients (18%) presented grades 3-4 gastrointestinal toxicity, and 11 (50%), grade 3 vaginal toxicity. CONCLUSION: Recurrent vaginal endometrial cancer is amenable to salvage therapy with HDRB and EBRT.     

HDR brachytherapy for the reirradiation of cervical and vaginal cancer: Analysis of efficacy and dosage delivered to organs at risk

Objective

To evaluate the efficacy and toxicity of HDR brachytherapy (BT) for the reirradiation of cervical or vaginal cancer arising within a previously irradiated area with a special focus on dosage delivery to organs at risk.

Methods

Twenty consecutive patients with cervical (N = 19) or vaginal (N = 1) cancer were reirradiated with curative intent using BT with or without external beam irradiation and hyperthermia. The median biologically equivalent dose in 2 Gy fractions (EQD2), assuming α/β = 10, for reirradiation was 48.8 Gy (range: 16.0–91.0 Gy), and the median cumulative EQD2 (for primary treatment and reirradiation) was 133.5 Gy (range: 96.8–164.2 Gy). The median follow-up after retreatment was 31 months (range: 6–86 months).

Results

The 3-year overall survival (OS) rate was 68% (95% confidence interval [CI]: 44%–91%). The 3-year disease-free survival (DFS) rate was 42% (95% CI: 19%–65%). The 3-year local control (LC) rate was 45% (95% CI: 22%–69%). For nine patients who received 3D treatment planning, the median cumulative EQD2 to 2 cm³ of rectum was 94.4 Gy (range: 67.1–118.8 Gy) and to 2 cm³ of bladder was 99.3 Gy (range: 70.4–122.3 Gy). Grade 3 late toxicity was observed in 3 patients (15%). An interval between primary RT and reirradiation of ≤ 12 months and a tumor diameter > 3 cm were significant prognostic factors adversely affecting OS, DFS and LC.

Conclusions

HDR BT is a valuable method for the reirradiation of cervical cancer. A cumulative EQD2 of approximately 100 Gy was safely delivered to 2 cm³ of the bladder and the rectum.     

Pilot study of vaginal plethysmography in women treated with radiotherapy for gynecological cancer

OBJECTIVE: After pelvic radiotherapy for gynecological cancer, changes in the vaginal epithelium might influence sexual arousal and satisfaction, leading to dyspareunia and relational problems. The aim of the study was to determine the feasibility of vaginal plethysmography in order to measure physical late effects of this therapy on sexual function. METHODS: Patients treated with radiotherapy for cervical, endometrial, or ovarian cancer, who were in complete remission for over 1 year, underwent vaginal plethysmography to measure changes in vaginal vasocongestion, while watching erotic video fragments. Afterward two questionnaires, designed to measure feelings of sexual arousal during the video, and to identify sexual dysfunction, were completed. The results were compared with those of healthy women. RESULTS: Patients (n = 9) and volunteers (n = 8) did not differ in baseline amplitude of plethysmography and showed comparable changes in vaginal vasocongestion during the various video fragments. The decline in amplitude during the last video fragment in the patient group did not reach significance, but the group of patients is small and heterogeneous. Addressing subjective sexual arousal during the video, patients reported less feelings of lust and desire and fewer bodily sensations while watching than the controls. Patients worried more about the sexual satisfaction of their partners than controls. CONCLUSION: Vaginal plethysmography can be used to measure vaginal vasocongestion in patients treated with radiotherapy to the proximal vagina. In this pilot study the changes of vaginal vasocongestion during sexual arousal between patients and healthy volunteers were not different. This correlates with a comparable sexual satisfaction, although patients reported less feelings of lust.     

Vaginal brachytherapy alone: an alternative to adjuvant whole pelvis radiation for early stage endometrial cancer

OBJECTIVE: Postoperative management of early stage adenocarcinoma of the endometrium remains controversial. The use of pelvic radiation therapy as shown by the Gynecologic Oncology Group (GOG)-99 trial improves the event free interval at the cost of increased toxicity. We reviewed and compared our results treating early stage endometrial adenocarcinoma using hypofractionated high dose rate (HDR) vaginal brachytherapy (VB) alone with the results of the GOG-99. METHODS: From 1992 to 2002, 243 endometrial cancer patients were treated with TAH/BSO and selective lymph node dissection followed by adjuvant radiotherapy (RT). Of these, 50 FIGO stage I-II (occult) adenocarcinoma (no clear cell or serous papillary) of the endometrium were managed with HDR hypofractionated VB as monotherapy using Iridium-192 to a dose of 30 Gy in 6 fractions twice weekly prescribed to a depth of 5 mm and median length of 4 cm. The characteristics, toxicity rates, and outcomes of our patients were compared with the results of the GOG-99. The median follow up of our patients and the GOG-99 were 3.2 years and 5.8 years, respectively. RESULTS: Patient characteristics including age, stage, and grade were similar in our study and the GOG-99. The local recurrence rate in our study, the pelvic RT arm of the GOG-99, and the no RT arm of the GOG-99 were 4% (n = 2), 2% (n = 3), and 9% (n = 18), respectively. In our study, one patient failed in the vagina alone and a second patient failed in the vagina and pelvis. In the GOG-99, the vagina as a component of locoregional failure was also the most common failure site in the no RT arm 77.8% (n = 14) and in the RT arm 100% (n = 3). The 2-year cumulative recurrence rate in our study was 2%, which compares favorably with the GOG-99 pelvic RT arm (3%) and observation arm (12%). Four-year survival rates of the no RT arm of the GOG-99, the RT arm of the GOG-99, and our study with HDR VB were 86%, 92%, and 97%, respectively. Chronic grade 2 toxicity rates were reduced by the use of VB compared to pelvic RT, especially GI toxicity 0% vs. 34% (P value < 0.001), and GI obstruction 0% vs. 7% (P value = 0.08). CONCLUSION: Stage I-II (occult) endometrial adenocarcinoma treated with postoperative HDR vaginal brachytherapy has similar overall survival, locoregional failure rates, and cumulative recurrence rates to standard fractionation external beam pelvic RT with the benefit of much lower toxicity rates and shorter overall treatment time.     

Predictive factors of recurrence following adjuvant vaginal cuff brachytherapy alone for stage I endometrial cancer

Purpose

The purpose of this study is to identify risk factors for recurrence in a cohort of stage I endometrial cancer patients treated with vaginal cuff brachytherapy at a single academic institution.

Methods and materials

From 1989 to 2011, 424 patients with stage I endometrial cancer underwent total hysterectomy and bilateral salpingo-oophorectomy, with or without lymphadenectomy (LND), followed by high-dose-rate vaginal cuff brachytherapy (VCB) to patients felt to be high or intermediate risk FIGO stage IA and IB disease. Covariates included: 2009 FIGO stage, age, grade, histology, presence of lymphovascular space invasion, LND, and receipt of chemotherapy.

Results

With a median follow-up of 3.7 years, the 5 and 10-year disease free survival were 98.4% and 95.9%, respectively. A total of 30 patients developed recurrence, with the predominant pattern of isolated distant recurrence (57.0%). On multivariate analysis, grade 3 (p = 0.039) and LND (p = 0.048) independently predicted of increased recurrence risk. χ² analysis suggested that higher-risk patients were selected for LND, with significant differences in age, stage, and grade noted between cohorts. Distant metastatic rate was significantly higher for patients who qualified for GOG 0249 at 23.1% (95% CI 10.7–35.5%) compared to those who did not at 6.8% (95% CI 1.8–11.8%, p < 0.001).

Conclusion

Overall disease-free survival for this cohort of patients was > 95% at 10 years. Univariate analysis confirmed previously identified risk factors as predictors for recurrence. Multivariate analysis found that grade 3 and LND correlated with risk for recurrence. Of those that did recur, the initial site of relapse included distant metastasis in most cases.     

252 锎中子腔内后装治疗子宫颈癌的临床观察

目的　观察2 52 锎中子腔内后装治疗宫颈癌的近期疗效以及并发症的发生情况 ,对该治疗方案进行初步评价。方法　选择 5 1例未曾接受过任何治疗的临床分期为Ⅱ、Ⅲ期的宫颈癌患者作为研究对象 ,其中Ⅱa期 8例 ,Ⅱb期 31例 ,Ⅲa期 8例 ,Ⅲb期 4例。治疗方案 :2 52 锎中子腔内后装治疗 ,宫旁A点 ,10～ 12Gy/次 ,1次 /周 ,共进行 3～ 4次 ,该治疗间歇穿插全盆腔外照射 ,前后对穿野 ,2 0 0cGy/次 ,4次 /周 ,外照射 2 0～ 30Gy后 ,盆腔野中央屏蔽挡铅 4cm ,2 0 0cGy/次 ,4次 /周 ,使总剂量达到 4 5～ 5 0Gy ,总疗程约 5～ 6周。结果　 5 1例患者均随访 2年 ,肿瘤的完全消退时间平均 2 5d ,2年局部控制率为 10 0 % ,2年生存率为 92 %。其中 ,临床分期Ⅱa期者 2年生存率为 8例中 8例 ,Ⅱb期中97% (30 / 31) ,Ⅲa期为 8例中 6例 ,Ⅲb期为 4例中 3例 ;肿瘤直径≥ 4cm者为 94 % (30 / 32 ) ,<4cm者为 19例中 17例。放射性膀胱炎、放射性直肠炎发生率均为 2 % (1/ 5 1)。结论　2 52 锎中子腔内后装治疗临床分期Ⅱ、Ⅲ期的宫颈癌具有局部控制率高、治疗时间短、患者放射治疗后并发症发生率低等特点 ,具有一定的临床应用前景