年轻宫颈癌患者卵巢功能保护的临床研究

目的 探讨年轻宫颈癌患者保留卵巢适应征范围及提高保留卵巢功能的方法 。方法 58例45岁以下宫颈癌患者实施了卵巢移位术,其中53例在根治术同时行卵巢移位术,包括6例宫颈腺癌病例及12例术前行髂内动脉介入化疗病例。术后辅助放疗16例。5例在根治性放疗前行单纯卵巢移位术。通过血清性激素水平的测定及随访性生活状况等评估术后卵巢功能。结果 58例卵巢移位术前术后血清性激素水平无统计学差别（P〉0.05）。卵巢移位术后放疗组雌、孕激素水平虽较未放疗组低（P〈0.05）,但仍显著高于根治性放疗组（P〈0.05）。随访中,无1例因卵巢转移复发。结论 卵巢移位术是保留年轻宫颈癌患者卵巢功能安全有效的方法 。恰当选择宫颈腺癌病例及通过新辅助化疗使部分中、晚期患者保留卵巢成为可能,尽可能的将卵巢移至远离放射野是提高保留卵巢功能的主要方法 。     

宫颈癌根治术中卵巢移位的价值

背景与目的： 探讨宫颈癌根治术中卵巢移位的价值。材料与方法：对75例45岁以下Ia2～IIb早期宫颈鳞癌患者于根治术中行单侧或双侧卵巢移位,通过血清性激素水平测定和超声检测等方法评估移位术后卵巢功能。结果： 卵巢移位术安全可靠,单侧或双侧卵巢移位后均无移位卵巢发生癌转移现象;移位后未辅加放疗组卵巢功能无明显变化,辅加放疗组雌、孕激素水平虽较未放疗组减低,但仍显著高于根治性放疗组。结论： 45岁以下宫颈癌患者根治术中保留卵巢安全有效,可显著提高患者雌、孕激素水平。     

放疗前微创卵巢移位术在年轻中晚期宫颈癌患者中的应用

目的:探讨放疗前微创卵巢移位术对行放射治疗年轻中晚期宫颈癌患者性激素水平、卵巢功能及生存率的影响。方法:研究对象选取我院2010年3月至2016年3月收治的年轻中晚期宫颈癌患者共110例,以随机数字表法分为对照组（55例）和观察组（55例）,对照组直接行放化疗治疗,观察组行微创卵巢移位术后开始放化疗治疗;比较两组患者治疗前后E2、FSH、LH水平,治疗后Kupperman评分,卵巢功能影响情况,随访生存率及复发率等。结果:两组患者治疗前性激素水平均显著优于治疗后（P<0.05）;观察组患者治疗后E2、FSH及LH水平均显著优于对照组（P<0.05）;观察组患者治疗后Kupperman评分显著低于对照组（P<0.05）;观察组患者卵巢功能影响情况显著优于对照组（P<0.05）;同时两组患者生存率和复发率比较差异无统计学意义（P>0.05）。结论:年轻中晚期宫颈癌患者于放疗前行微创卵巢移位术可有效保护卵巢功能,调节性激素水平,缓解围绝经期症状,且未对生存时间和复发风险产生不利影响。     

宫颈癌根治术时行卵巢移植术或移位术的远期疗效

目的：探讨早期子宫颈癌患者几上不同保留卵巢手术方式的效果及术后放疗对保留卵巢的影响。方法：２６例４１岁以前的宫颈癌患者行根治手术的同时，２例行卵巢移植术，２４例行卵巢移位术，利用Ｂ超及测定血清性激素水平等方法定期监测保留卵巢的功能。结果：接受卵巢移植术者，术后６个月卵巢开始周期性增大，术后９～１５个月恢复正常。１例随访１２年，卵巢功能正常。１例随访１０年，术后９年血清性激素值接近绝经期水平。卵巢移     

腹膜外卵巢移位术与改良卵巢移位术对宫颈癌患者卵巢功能的影响

目的探讨腹膜外卵巢移位术与改良卵巢移位术对宫颈癌患者卵巢功能的影响。方法选取2010年3月至2015年9月间山东潍坊临朐县人民医院收治的140例宫颈癌患者,采用随机数表法将患者分为观察组和对照组,每组70例。观察组行改良卵巢移位术,对照组行腹膜外卵巢移位术。比较两组患者治疗前后孕酮(P)、卵泡刺激素(FSH)、黄体生成素(LH)及雌二醇(E)含量,并发症发生率及随访24周性生活满意度。结果两组患者治疗前P、FSH、LH及E值比较,差异均无统计学意义(均P>0.05)。两组患者治疗后较治疗前比较P值升高、FSH、LH和E值降低,但差异均无统计学意义(均P>0.05)。两组治疗后P、FSH、LH及E值比较差异无统计学意义(P>0.05)。观察组并发症发生率为10.0%,对照组并发症发生率为21.4%,观察组较对照组相比并发症发生率明显降低,差异有统计学意义(P<0.05)。对照组性生活满意率为81.4%,观察组性生活满意率为91.4%,观察组较对照组比较性生活满意明显提高,差异有统计学意义(P<0.05)。结论腹膜外卵巢移位术与改良式卵巢移位手术治疗宫颈癌都可以有效保留卵巢的功能,改良式卵巢移位术可减少并发症的发生,显著提高患者术后性生活满意度。     

保留卵巢功能对宫颈癌患者放疗后生活质量的影响

目的探讨保留卵巢功能对宫颈癌患者放射治疗后内分泌及生活质量的影响。方法1995年6月~2001年6月对年龄35岁下,临床Ⅰ、Ⅱ期的宫颈癌患者64例随机分成两组实验组(卵巢移位 放疗)32例,先行手术将卵巢保留并移位至照射区外5cm处,然后行盆腔根治性放疗;对照组(单纯放疗)32例,直接行盆腔根治性放疗。观察两组放疗后性激素水平变化及临床表现,并进行对照分析。结果实验组放疗后血清FSH、LH、E2、T值较放疗前无显著变化(t=0·72,P>0·05),阴道细胞学检查有雌激素影响。B超示卵巢有周期性增大改变,临床表现无怕热、心烦、多汗、肥胖、皮肤粗糙等内分泌失调症状。对照组放疗后FSH、LH值显著增高(t=15·53,P<0·01),E2值都显著降低(t=6·61,P<0·01),阴道细胞学检查无雌激素影响。B超示卵巢无周期性变化,临床表现有怕热、多汗、烦躁、皮肤粗糙等内分泌失调症状。与实验组比较(χ2=32·0,P<0·01),结果证明卵巢移位后能避免卵巢功能丧失。结论保留卵巢功能可以提高年轻宫颈癌患者放射治疗后的生活质量。     

放疗对宫颈癌根治术患者卵巢功能影响

目的 在保留并移位卵巢的ⅠB1-ⅡA2期根治术后需辅助放疗的年轻宫颈癌患者中,评估移位卵巢剂量学参数与临床不同卵巢功能状态之间相关性。方法 回顾2015-2017年间86例患者疗前和疗后2年内移位卵巢功能和临床相关症状,并评价放疗技术中移位卵巢的剂量学参数以及移位卵巢的功能状态之间的相关性。术后放疗采用不同体外保护移位卵巢,68例IMRT或VMAT,18例二维等中心放疗。结果 卵巢和PTV最近距离与卵巢剂量≥V5Gy呈负相关(P=0.025)。V8Gy、Dmean与疗后FSH(为卵巢血清卵泡刺激素,FSH)呈正相关(P=0.011、0.020)。即V8Gy体积越大Dmean越高,疗后FSH越高卵巢功能越差。二维技术中≥V5Gy低于三维技术,剂量降低明显。疗后卵巢功能正常者平均年龄33.4岁,而卵巢功能衰竭者平均年龄39.6岁(P=0.007)。不同卵巢状态患者间保留卵巢数目、是否同步化疗均相近,但与疗前FSH、E2(雌二醇)水平相关,即疗前FSH水平越高E2越低,疗后卵巢FSH水平越高E2越低。疗前保留卵巢但功能衰竭者均进行了新辅助化疗且年龄略高。结论 年龄,卵巢 V_{8 Cy}、D_mean,悬吊卵巢与 PTV 最近距离,疗前有无新辅助化疗及放疗技术均会影响移位卵巢功能的保护。     

腹腔镜卵巢移位对年轻中晚期宫颈鳞癌患者同步放化疗后卵巢功能的影响

目的:研究腹腔镜卵巢移位对年轻中晚期宫颈癌同步放化疗后卵巢功能的影响。方法:对我院2012至2016年年轻中晚期宫颈癌进行同步放化疗的患者进行对照研究,将患者分为手术组和对照组,比较两组患者身高、体重、体重指数、术前血清促卵泡成熟激素（FSH）、黄体生成激素（LH）和雌二醇（E2）水平。首次放化疗后3、6、12个月检查患者血清中FSH、LH、E2以及Kupperman评分,比较两组患者的差异。结果:经筛选后共47例患者纳入研究,其中手术组20例,对照组27例。两组患者术前各项参数均无差异（P＞0.05）。治疗后3个月两组患者各项指标均无差异（P＞0.05）。治疗后6个月和12个月手术组患者血清FSH低于对照组（P＜0.05）,E2高于对照组（P＜0.05）,Kupperman评分低于对照组（P＜0.05）。治疗后12个月手术组患者血清LH水平低于对照组（P＜0.05）。结论:腹腔镜卵巢移位术对年轻中晚期宫颈癌同步放化疗后卵巢功能的保护具有积极作用。     

宫颈癌患者卵巢移位手术后放射治疗对卵巢功能的作用分析

目的探讨卵巢移位术对宫颈癌患者放射治疗后卵巢功能的作用。方法选取2008年5月至2012年5月收治的40例宫颈癌患者为研究对象,行卵巢移位术治疗,并按照患者放射治疗指征在手术后进行放射性治疗,观察其手术前、手术后和放射治疗结束1个月后和放射治疗结束6个月后血清中性激素水平以及随访情况。结果手术后患者血清性激素水平无明显变化,化疗结束1个月后垂体分泌卵泡刺激素（FSH）和促黄体生成素（LH）水平明显上升,雌二醇（E2）和孕酮（P）水平明显下降（P〈0．05）,并于化疗结束6个月后恢复手术前水平。放射治疗结束6个月后,25例患者出现潮热、盗汗、烦躁、失眠等围绝经期症状,性生活满意度为37．5％,且复发1例,手术后生活质量（QOL）满意度为51．2％,无死亡病例。放射治疗结束1年后围绝经期症状自行消失,仅3例患者存在围绝经期症状,性生活满意度为95．0％,QOL满意度96．4％,2例复发,患者全部生存。放射治疗结束6个月与1年后两组在围绝经期症状、性生活满意度和QOL满意度差异均具有统计学意义（P〈0．05）。结论卵巢移位术能够有效保护宫颈癌患者放射治疗后卵巢功能,操作方便、疗效可靠,且明显降低了复发率,对患者手术后生活质量的提高具有重要意义,值得临床广泛推广。     

卵巢同种自体移植、移位术通过鉴定

目前,临床治疗宫颈癌无论是根治术还是放射治疗,对卵巢都是一种破坏性损伤,无疑给病人尤其是年轻病人带来诸多痛苦。为了提高年轻宫颈癌患者的生存质量,保留卵巢功能和女性第二性征,湖北省肿瘤医院妇癌科徐名秋主任和刘力大夫经过几年探索,成功地进行了卵巢同种自体移植、移位术。移植术是在行宫颈癌切除术的同时,将卵巢移植到患者前臂屈面;移位术则是将卵巢上移至右肋弓下皮下窝内。这样既可使卵巢在行术后放疗时免受放射线损伤,     

The Life Quality and Sexual Function of Women Underwent Radical Hysterectomy

Background: Up to date, there no studies were conducted on the quality of life (QL) and sexual function (SF) of women from Kazakhstan treated for cervical cancer. The study was aimed at the assessment of the QL and SF of women of the Kazakh population who underwent radical hysterectomy compared with chemo-radiotherapy group. Methods: The study was conducted prospectively on 157 women of the Kazakh population. 92 women underwent radical hysterectomy (RH) and 65 underwent chemo-radiotherapy (CRT). The information was collected before treatment (T1), 6 months (T2) and 12 months (T3) after treatment. Results: The women’s average age was 41.12 ± 5.4 in the RH group and 47.24 ± 6.1 in the CRT group (p = 0.2). We did not detect significant differences between both groups according to the QLQ C-30 questionnaire (T1). The differences between the RH and CRT groups (p≤0,05) were observed in terms of physical functioning, fatigue, nausea and vomiting, pain during the T2 period. High rates of emotional functioning (p = 0.03), global health and QL (p = 0.02), and symptoms of fatigue (p = 0.04) were detected in the RH group compared to the CRT group during T3. However, pain symptoms (p = 0.001), nausea and vomiting and loss of appetite (p = 0.03) were dominated the CRT group. According to the results of FSFI-6 in the RH group, indicators for the domains “desire” (p = 0.02), “excitement” (p = 0.03), and “orgasm” (p = 0.05) were high, unlike in the CRT group during the T3 period. Nevertheless, the number of complains on the ‘pain during intercourse’ in the CRT group was higher than in the RH group (p = 0.001). Conclusion: Women who underwent RH had better health scores, global health status, and SF compared with patients treated with CRT.     

Comparison of outcomes between radical hysterectomy followed by tailored adjuvant therapy versus primary chemoradiation therapy in IB2 and IIA2 cervical cancer

Objective

To compare survival outcomes and treatment-related morbidities between radical hysterectomy (RH) and primary chemoradiation therapy (CRT) in patients with bulky early-stage cervical cancer.

Methods

We selected 215 patients with stage IB2 and IIA2 cervical cancer (tumor diameter > 4 cm on magnetic resonance imaging) who underwent RH followed by tailored adjuvant therapy (n=147) or primary CRT (n=68) at two tertiary referral centers between 2001 and 2010.

Results

About twenty nine percent of patients were cured by RH alone and these patients experienced the best survival outcomes with the lowest morbidity rates. After the median follow-up times of 40 months, 27 RH (18.4%) and 20 CRT (29.4%) patients had recurrence (p=0.068) and 23 (15.6%) and 17 (25%) patients died of disease (p=0.101). The 5-year progression-free survival were 77% and 66% (p=0.047), and the 5-year overall survival were 78% and 67% (p=0.048) after RH and primary CRT, respectively. In multivariate analysis, patients who received primary CRT was at higher risk for tumor recurrence (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.24 to 4.14; p=0.008) and death (OR, 3.02; 95% CI, 1.53 to 5.98; p=0.001) than those who received RH. Grade 3-4, early (17% vs. 30.9%, p=0.021) and late (1.4% vs. 8.8%, p=0.007) complications were significantly less frequent after RH than primary CRT.

Conclusion

Thirty percent of patients were cured by RH alone. A treatment outcome was better in this retrospective study in terms of morbidity and survival. Randomized trials are needed to confirm this result.     

Does preoperative therapy optimize outcomes in patients with resectable pancreatic cancer?

The objective of this study was to compare survival between all patients with radiographically resectable adenocarcinoma of the proximal pancreas who underwent preoperative chemoradiation therapy (PRE‐OP CRT) or surgical exploration first (SURGERY) with “intention to resect.” Pancreatic cancer patients who undergo resection after PREOP CRT live longer than patients who undergo resection without PREOP CRT, a difference that may be attributable to patient selection. We retrospectively identified 236 patients with pancreatic head adenocarcinoma seen between 1999 and 2007 with sufficient data to be confirmed medically and radiographically resectable. The outcomes of 144 patients who underwent PREOP CRT were compared to those of 92 patients who proceeded straight to SURGERY. The groups were similar in age and gender. Tumors were slightly larger in the PREOP CRT group (mean 2.5 cm vs. 2.1 cm, P < 0.01), and there were trends toward more venous abutment (54% vs. 39%, P = 0.06) and a higher Charlson comorbidity index (P = 0.1). In the PREOP CRT group, 76 patients (53%) underwent resection, 28 (19%) had metastatic and 17 (12%) locally unresectable disease after PREOP CRT, and 23 (16%) were not explored due to performance status or loss to follow‐up. In the SURGERY group, 68 patients (74%) underwent resection. Sixteen patients (17%) had metastatic and eight patients (9%) locally unresectable disease at exploration. In patients who underwent resection, the PREOP CRT group had smaller pathologic tumor size and lower incidence of positive lymph nodes than the SURGERY group but no difference in positive margins or need for vascular resection. Median overall survival (OS) in patients undergoing resection was 27 months in the PREOP CRT group and 17 months in the SURGERY group (P = 0.04). Median OS in all patients treated with PREOP CRT or surgically explored with intention to resect was 15 and 13 months, respectively, with superimposable survival curves. Despite a lower resection rate, the PREOP CRT group as a whole had a similar OS to the SURGERY group as a whole. For patients who underwent resection, those in the PREOP CRT had longer survival than those in the SURGERY group, suggesting that PREOP CRT allows better patient selection for resection. PREOP CRT should be considered an acceptable alternative for most patients with resectable pancreatic cancer. J. Surg. Oncol. 2012; 106:111–118. © 2012 Wiley Periodicals, Inc.     

Combined chemo- and radiotherapy vs. radiotherapy alone in the treatment of primary, nonresectable adenocarcinoma of the rectum

PURPOSE: In a randomized study in primarily inextirpable rectal cancer, conventional radiotherapy to reduce the tumor mass was compared with combined chemotherapy and radiotherapy. METHODS AND MATERIALS: The combined treatment (CRT) was given every other week, four times, during a 7-week period. The drugs used were methotrexate, 5-fluorouracil in bolus injection followed by continuous infusion and leucovorin rescue. Radiotherapy (RT) was given simultaneously with five 2-Gy fractions in 3 days to a dose of 10 Gy to a total dose in the four courses of 40 Gy. This regimen was compared with radiotherapy in 2-Gy fractions to a total dose of 46 Gy in the radiotherapy group. Surgery was performed 3-4 weeks after finished treatment. Seventy patients were included between November 1988 and August 1996; 36 patients were allocated to RT and 34 to CRT. RESULTS: Twenty-five (74%) of the patients in the CRT group underwent a locally radical resection with 20 (59%) patients without any known metastases. The corresponding figures in the RT group were 23 (64%) and 18 (50%), respectively. Among the patients who underwent any tumor resection, 5/29 (17%) in the CRT group and 12/27 (44%, p = 0.05) in the RT group have had a local recurrence. After a locally radical resection, the corresponding figures are 4% and 35% (p = 0.02), respectively. Local disease-free survival was significantly superior in the CRT group (66% at 5 years) compared with the RT group (38%, p = 0.03 log-rank test). Five-year survival was 29% (9 patients) in the CRT group and 18% (6 patients) in the RT group, a nonsignificant difference (p = 0.3). Five patients in the RT group did not complete planned treatment, mainly due to the appearance of metastatic disease. In this group toxicity was usually of Grade 0-1. In the experimental group, the toxicity usually was Grade 2 or higher, and 6 patients did not manage to fulfill the planned treatment due to toxicity. CONCLUSION: In this study, with fewer included patients than intended, resectability rates were high in both groups. The addition of chemotherapy to radiotherapy significantly improved local control rates, but no statistically significant difference was found in survival between the groups. The acute toxicity after CRT was higher than after RT alone, but manageable.     

新辅助放化疗对mrT3 期低位直肠癌患者不同浸润深度远期疗效的影响*

目的：探讨新辅助放化疗（neoadjuvant chemoradiotherapy ,CRT ）对cT 3 期低位直肠癌及其各亚分期预后的影响,进一步评估是否所有T 3 期低位直肠癌患者均应行CRT 。方法：对2008年1 月至2012年12月间福建医科大学附属协和医院结直肠外科收治的223 例cT 3 期低位直肠癌患者,按北美放射协会（RSNA）影像学分期标准回顾性进行亚分期,即根据高分辨率MRI 测量下肿瘤浸润直肠系膜的深度（depth of mesorectal invasion,DMI）分为mrT3a 期（DMI<5 mm）,mrT3b 期（DMI 为5～10mm）和mrT3c 期（DMI>10mm）,并根据是否行CRT 分为新辅助放化疗组（CRT 组,115 例）和未行新辅助放化疗组（nCRT组,108 例）,比较两组患者及其
各亚分期（mrT3a、mrT3b、mrT3c）之间预后的差异。结果：对于整体mrT3 期,CRT 组和nCRT组的3 年无病生存率（78.2% vs . 71.9% ,P =0.608）和局部复发率（4.4% vs . 8.5% ,P = 0.120）无统计学差异。对于mrT3 各亚分期,CRT 组和nCRT组预后分别为：mrT3a：3 年无病生存率82.4% vs . 81.8%（P = 0.837）、局部复发率5.8% vs . 5.9%（P = 0.658）;mrT3b：3 年无病生存率84.4% vs . 42.4%（P = 0.032）、局部复发率0 vs . 18.2%（P = 0.014）;mrT3b、mrT3c：3 年无病生存率72.8% vs . 42.4%（P = 0.060）、局部复发率2.4% vs . 18.2%（P = 0.021）。 单因素分析提示DMI 和环周切缘（circumferential resection margin ,CRM）是mrT3 期直肠癌患者3 年无病生存时间的影响因素,Cox 风险回归模型多因素分析提示CRM是独立影响因素（OR= 2.249,CI ：1.067～4.742,P = 0.033）。 结论：CRT 能改善mrT3b、mrT3c 期低位直肠癌患者的预后,但可能无法改善mrT3a 且CRM阴性低位直肠癌患者的预后,对这部分患者可直接行手术治疗。     

Pre-operative chemo-radiotherapy improves the sphincter preservation rate in patients with rectal cancer located within 3 cm of the anal verge.

AIMS: To evaluate whether pre-operative chemo-radiotherapy (CRT) improves the sphincter preservation rate for distal rectal cancers within 3 cm of the anal verge. METHODS: Between January 2001 and December 2004, 49 patients underwent surgery with or without pre-operative CRT for primary rectal adenocarcinoma within 3 cm of the anal verge. Clinical data were retrospectively reviewed, including stage workups, surgical records and pathology records to determine sphincter preservation rate and the factors influencing sphincter preservation. RESULTS: Of 49 patients with rectal tumours within 3 cm of the anal verge, 31 underwent pre-operative CRT followed by surgery (CRT group), and 18 underwent surgery alone (non-CRT group). Sphincter preservation was possible in 11 of 31 CRT patients, and only one of 18 non-CRT patients (p=0.036). The factors most influencing sphincter preservation were reduction in tumour size (p=0.005) and downstaging (p=0.001) following pre-operative CRT. CONCLUSION: We could observe that sphincter preservation was improved in CRT group with statistical significance when compared to non-CRT group in our study patients with rectal cancer within 3 cm of the anal verge.     

The role of surgery and postoperative chemoradiation therapy in patients with lymph node positive esophageal carcinoma.

BACKGROUND: Patients who have undergone resection for lymph node positive esophageal carcinoma are at high risk of disease recurrence and early death. The role of postoperative adjuvant therapy in this population needs to be determined. METHODS: A retrospective review of all patients with resected esophageal carcinoma between 1991 and 1997 was performed. Lymph node positive (N1) patients who received concurrent or sequential postoperative radiotherapy (50 grays) and chemotherapy (cisplatin, 5-fluorouracil with or without epirubicin) were compared with N1 patients who underwent surgery alone. The disease free and overall survival rates were calculated using the Kaplan-Meier method, and groups were compared with the log-rank test. Prognostic variables were entered into a Cox regression model controlling for age, weight loss, T status, Eastern Cooperative Oncology Group (ECOG) score, and treatment received. RESULTS: A total of 165 patients were reviewed: Twenty-eight N1 patients underwent surgery alone (S group), and 38 N1 patients underwent surgery and received postoperative chemoradiation therapy (CRT group). Preoperative risk factors, tumor characteristics, ECOG scores, and lengths of hospital stay were similar. The disease free survival rates were similar (S group, 10.6 months; CRT group, 10.2 months), although the S group had more local disease recurrences (S group, 35%; CRT group, 13%; P = 0.09). The overall survival rate according to the Kaplan-Meier analysis showed a significant survival advantage with postoperative CRT radiation (log-rank test; P = 0.001). The median overall survival for the CRT group was 47.5 months, which was significantly longer than that of the S group (14.1 months). The ECOG score, T status, and treatment received all were found to influence survival significantly on univariate analysis. In the multivariate model, postoperative CRT was a predictor of survival (P = 0.007; risk ratio for mortality, 0.35; 95% confidence interval, 0.16-0.76) and was correlated with a significantly decreased risk of death in patients with lymph node positive, resected esophageal carcinoma. CONCLUSIONS: Postoperative CRT appears to prolong survival in patients with lymph node positive, resected esophageal carcinoma.     

Quality of Life in Cervical Cancer Survivors and Healthy Women: Thai Urban Population Study

Background : To determine a baseline quality of life (QoL) in cervical cancer survivors compared to that of healthy subjects in the tertiary Thammasat University Hospital, Thailand. Materials and Methods: The investigation was conducted at the outpatient gynecological department of Thammasat University Hospital between January and June 2016. A total of 192 women were entered into the study (97 cervical cancer survivors; 37 after radical hysterectomy (RH), 43 with concurrent chemoradiation (CRT), and 17 featuring both RH and CRT; and 95 control subjects from the same outpatient department with no history of malignancy). Participant QoL was assessed using a Thai version of the EORTC-QLQ-C30 (European Organization for Research Treatment of Cancer Quality-of-Life) and a general survey for the assessment of sociodemographic data was also conducted. Results: There were significant differences in physical, role, emotional and social functions between cervical cancer survivor and control groups. Global health, fatigue, pain, appetite loss, and financial difficulties also demonstrated statistically significant variation. Cervical cancer survivors treated by RH had higher scores for emotional and social function and global health than the control group. Moreover, they had less appetite loss, fatigue and financial difficulties. However, patients treated with CRT experienced more pain than the control group. All cervical cancer survivors had lower physical function scores than the control group. Conclusion: Quality of life in cervical cancer survivors is better than in healthy peers in some domains. Cervical cancer survivors treated with RH may have a better QoL than healthy peers. Early detection for early stage cervical cancer remains most important because treatment in early stages does not cause lowering of the QoL.     

容积CT灌注成像预测宫颈鳞癌放化疗疗效的初步研究

目的:探讨容积CT灌注成像(vCTP)在预测宫颈鳞癌(CSC)放化疗疗效中的应用价值。方法:对22例经病理活检证实并拟行放化疗治疗的宫颈鳞癌患者行全子宫容积CT灌注扫描,治疗结束后1个月内行常规增强CT复查。按照实体瘤疗效评价标准进行患者分组。对不同疗效组患者的一般资料、宫颈鳞癌血流量（AF）、血容量（BV）及渗透性（PS）、髂外动脉AF进行t检验或Fisher精确概率检验,有统计学差异的CT灌注参数进一步采用ROC曲线分析。结果:22例患者在放化疗后达CR 15例、PR 7例。两组患者年龄、体重指数（BMI）、FIGO分期、病理分级、治疗前肿瘤最长径及最大面积均无统计学差异（P>0.05）;不同疗效患者宫颈鳞癌AF和髂外动脉AF比较,差异均有统计学意义（P<0.05）,CR组明显高于PR组;而宫颈鳞癌BV和PS两组间无统计学差异（P>0.05）。ROC曲线分析显示,宫颈鳞癌AF和髂外动脉AF预测宫颈鳞癌放化疗后达CR的AUC分别为0.829和0.876。结论:容积CT灌注参数AF有助于预测宫颈鳞癌放化疗疗效。     

Consolidation Chemotherapy Rather than Induction Chemotherapy Can Prolong the Survival Rate of Inoperable Esophageal Cancer Patients Who Received Concurrent Chemoradiotherapy

Concurrent chemoradiotherapy (CRT) is regarded as the standard treatment for inoperable esophageal cancers (EC). It is still controversial whether consolidation chemotherapy (CCT) or induction chemotherapy (IC) is beneficial for the patients who received CRT. Therefore, we carried out a retrospective analysis at our institution. A total of 186 inoperable EC patients from 20 October 2017 to 7 June 2021 who have previously received CRT were included in our study. The patients were divided into IC + CRT (n = 52), CCRT (n = 64), and CRT + CCT (n = 70) groups according to whether they received induction chemotherapy, consolidation chemotherapy, or not. We used Kaplan–Meier statistics to analyze their 1-, 2-, and 3-year OS. The median follow-up time for the whole group was 14.15 months. The 1-, 2-, 3- year overall survival (OS) for the CCRT group were 72.2%, 52.5%, and 29.5%, and 50.9%, 37.5%, and 25% for the IC + CRT group (p > 0.05). For the CRT + CCT group,1-, 2-, and 3-year OS were 89.8%, 59.0%, and 42.5% (p < 0.05). Adverse reactions in the three groups were mainly graded 0–3. The difference between the three groups was not statistically significant (p > 0.05). For non-surgical EC patients who received CRT, CCT after CRT but not IC before CRT can improve 1-, 2-, and 3-year OS with a low incidence of associated severe adverse effects. As a result, the addition of consolidation chemotherapy to chemoradiotherapy has significant prognostic advantages for inoperable EC patients.