腹主动脉旁淋巴结切除术在宫颈癌中的价值及争议

摘 要：宫颈癌中淋巴结的转移与疾病分期、预后、治疗方式的选择密切相关,腹主动脉旁淋巴结（para-aortic lymph node,PLAN）转移是预后不良的一个独立因素。国际妇产科联盟（FIGO）2018年对宫颈癌分期做出了修改,将影像学或组织病理学证实的主动脉旁淋巴结转移患者定为ⅢC2期。2020年美国国立综合癌症网络(NCCN) 宫颈癌治疗指南指出,对ⅠB1~ⅡA2宫颈癌患者可选择腹主动脉旁淋巴结取样术,对ⅡB~ⅣA期患者可选择分期手术即先行腹膜外或腹腔镜下淋巴结切除术。但是目前宫颈癌患者的腹主动脉旁淋巴结清扫术（para-aortic lymphadenectomy,PAL）仍缺乏足够的证据,另外腹主动脉旁淋巴结清扫水平如何定位、PAL能否延长患者生存期等问题仍存在较多争议。全文针对这些问题作一简要综述。     

KLF6、p21表达与中晚期宫颈癌同步放化疗敏感性的关系

目的:探讨Kruppel样因子6（KLF6）、p21蛋白表达与中晚期（Ⅱb-Ⅲb）宫颈癌同步放化疗敏感性的关系。方法:选取108例Ⅱb-Ⅲb期宫颈癌患者作为受试对象,均行同步放化疗,根据病变好转情况分为放化疗敏感组81例和放化疗不敏感组27例。用免疫组织化学法检测所有受试者组织中KLF6、p21蛋白水平,分析二者表达与Ⅱb-Ⅲb期宫颈癌患者同步放化疗敏感性及3年总生存率（OS）的关系。结果:放化疗敏感组与不敏感组患者的肿瘤分化程度、肿瘤大小差异有统计学意义（P＜0.05）;两组患者年龄、FIGO分期、淋巴结转移及化疗方案差异均无统计学意义（P＞0.05）。KLF6蛋白低表达患者同步放化疗总有效率明显低于高表达患者（P＜0.05）,p21蛋白低表达患者总有效率显著高于高表达患者（P＜0.05）。KLF6、p21蛋白表达与Ⅱb-Ⅲb期宫颈癌患者FIGO分期、肿瘤分化程度、肿瘤大小及放化疗敏感性有关（P＜0.05）。KLF6低表达患者OS明显低于高表达患者（P＜0.05）;p21高表达患者OS显著低于低表达患者（P＜0.05）。多因素分析显示KLF6、p21表达是影响患者预后的独立危险因素（P＜0.05）。结论:KLF6高表达、p21低表达的Ⅱb-Ⅲb期宫颈癌患者同步放化疗敏感性强,其放化疗总有效率及3年OS均较高,可作为预后判断的依据。     

预防性EFRT应用于晚期宫颈癌的研究进展

宫颈癌是妇科常见恶性肿瘤,其发病率和死亡率在女性恶性肿瘤中居第四位。淋巴结转移是其最主要的转移方式,也是宫颈癌的重要独立预后不良因素。考虑到腹主动脉旁淋巴结转移的漏诊率较高,及宫颈癌治疗后腹主动脉旁淋巴结转移导致的治疗失败率较高,近年来有临床医生将预防性延伸野放疗应用于Ⅲ B及Ⅲ c1宫颈癌患者的治...     

放化疗同步治疗中晚期宫颈癌的疗效分析

目的探讨放化疗同步治疗中晚期宫颈癌的临床疗效、不良反应及相关预后因素。方法对137例确诊为宫颈癌患者的临床资料进行回顾性研究。137例分为2组,68例采用根治性放疗+顺铂,为同步放化组;69例采用单纯根治性放疗,为单纯放疗组。比较2组近期疗效、3年生存率及不良反应,同时对同步放化疗组进行相关预后因素分析。结果治疗结束3个月,同步放化组的完全缓解率、有效率(42.6%、91.2%)均优于单纯放疗组(26.1%,78.3%),P<0.05。同步放化组3年生存率(75.0%),与单纯放疗组(58.0%)比较,差异有统计学意义(P<0.05)。单因素分析显示:肿瘤大小、病理类型、临床分型、治疗前淋巴结有无转移、是否贫血是同步放化疗3年生存率的预后影响因素,多因素Logistic回归分析显示:肿瘤大小、病理类型及治疗前淋巴结有无转移是其独立预后影响因素。结论同步放化疗可以提高中晚期宫颈癌的近期疗效,远期生存也可明显获益。预后与肿瘤大小、病理类型、治疗前有无淋巴结转移、临床分型、贫血等相关。     

ⅠB2及ⅡA2期宫颈癌患者的手术治疗方案研究

目的探讨ⅠB2及ⅡA2期宫颈癌患者宫颈癌根治术中加行腹主动脉旁淋巴结切除的价值。方法选择2007年1月至2012年12月手术治疗的ⅠB2~ⅡA2期宫颈癌患者70例,其中33例行宫颈癌根治术加腹主动脉旁淋巴结切除术作为观察组,37例行宫颈癌根治术作为对照组,比较2组术后并发症发生率、复发率及生存率。结果 2组患者术中出血量、手术时间及并发症发生率比较,差异无统计学意义(P>0.05)。腹主动脉旁淋巴结转移与盆腔淋巴结转移个数有关,盆腔淋巴结转移>1个更容易发生腹主动脉旁淋巴结转移(P<0.05),2组患者复发率比较差异有统计学意义(P<0.05),生存率比较差异没有统计学意义(P>0.05)。结论宫颈癌根治术加行腹主动脉旁淋巴结切除安全可行,可以降低患者术后复发率,但不能明显改善患者的生存率。     

子宫内膜癌患者盆腔加腹主动脉旁淋巴结切除的临床意义

目的 分析子宫内膜癌患者盆腔加腹主动脉旁淋巴结切除的临床意义.方法 选取子宫内膜癌患者71例为研究对象,行盆腔加腹主动脉旁淋巴结切除术,分析患者术后临床特征,以及影响患者盆腔及腹主动脉旁淋巴结转移的危险因素.结果 对盆腔及腹主动脉旁淋巴结患者行切除术后淋巴结转移率较低,分别为21.2%和23.9%,且患者术后并发症较少,仅为7例;线性回归分析提示,影响盆腔淋巴结转移的独立危险因素有肿瘤中低分化、深度肌层浸润、临床分期及脉管浸润,而影响腹主动脉旁淋巴结转移的独立危险有肿瘤低分化、非子宫内膜样癌、深度肌层浸润、盆腔淋巴结转移及淋巴管浸润;71例患者随访1年生存率为87.32%,且发生盆腔加腹主动脉旁淋巴结转移患者的生存率明显低于无淋巴结转移者.结论 盆腔加腹主动脉旁淋巴结切除,有利于提高子宫内膜癌患者的临床治疗效果,而且安全性较高,值得临床推广应用.     

早期宫颈癌术后辅助治疗疗效分析

目的:研究宫颈癌术后辅助治疗的选择与疗效.方法:回顾性分析159例宫颈癌根治术后辅助放疗加或不加化疗的患者治疗效果,选取130例同期行宫颈癌根治术的Ⅰb期及Ⅱa期未作术后辅助治疗患者作为对照组,进一步分析宫颈癌预后因素.159例患者中有87例放疗化疗综合治疗,72例单纯放疗.结果:289例患者总的5年生存率为89.3%,(单纯放疗组5年生存率88.9 % ,放疗化疗综合治疗5年生存率为 89.7%),对照组5年生存率72.9%.两者差异有显著性(P<0.05).结论:宫颈癌术后辅助治疗尤其对于盆腔淋巴结转移者有意义,临床和术后病理分期是术后辅助治疗的选择与疗效最主要的影响因素,不同病理类型及分级的宫颈癌术后辅助治疗可有不同的选择.     

延伸野IMRT对宫颈癌预后研究进展

近几十年精确放疗技术发展迅速,IMRT在妇科恶性肿瘤中的应用也逐渐增加。研究表明在晚期宫颈癌患者中有很高的隐匿性腹主动脉旁淋巴结转移的发生率,而盆腔和腹主动脉旁淋巴结状态是宫颈癌患者重要预后影响因素。既往预防性延伸野常规放疗存在严重胃肠道副反应,联合同步化疗也存在争议。现有研究对于转移性盆腔及腹主动脉旁淋巴结的最佳放疗剂量也未达成共识。本文主要分析预防性延伸野IMRT联合同步化疗对宫颈癌患者预后影响和淋巴结阳性区域剂量效应关系。     

215例老年宫颈癌的临床分析

目的 探讨老年官颈癌的临床特点、治疗效果以及影响预后的因素.方法 回顾性分析215例年龄≥65岁的老年宫颈癌患者的临床资料.215例患者中,192例为Ⅱ b～Ⅳ期的中晚期患者,占89.3%;8例(3.7%)行手术治疗,其中6例术后辅以体外放疗;207例(96.3%)采用放射治疗,其中74例采用同步放化疗.结果 全组患者总的5年生存率为63.7%,Ⅰ、Ⅱ、Ⅲ和Ⅳ期患者的5年生存率分别为83.2%、76.4%、39.0%和0.同步放化疗者与单纯放疗者的5年生存率分别为54.1%和59.6%,差异无统计学意义(P=0.4880).多因素分析表明,临床分期、组织学分级、病理类型以及有无淋巴结转移是影响老年宫颈癌患者预后的独立因素(均P<0.05).结论 对于老年宫颈癌患者,治疗宜个体化,应根据患者的具体情况选择合适的治疗方式,尽量选取一种根治手段,不建议综合治疗.     

早期宫颈癌髂总淋巴结转移相关因素及预后临床分析

目的 探讨Ⅰ B1～ⅡA2期宫颈癌髂总淋巴结转移的相关因素及预后,为指导临床治疗提供依据.方法 回顾性分析1997-06 12-2013-06-30山东省肿瘤医院收治的行广泛子宫切除+盆腔淋巴清除术284例Ⅰ B1～ⅡA2期宫颈癌患者的临床病理资料.结果 在284例患者中有盆腔淋巴结转移82例,转移率为28.9％.其中髂总淋巴结转移率为5.3％(15/284),腹主动脉旁淋巴结转移率为2.8％(8/284).单因素分析显示,淋巴血管间隙浸润、盆腔其他淋巴结转移是髂总淋巴结转移的危险因素,P＜0.05.多因素分析显示,盆腔其他淋巴结转移为髂总淋巴结转移的独立危险因素,OR=35.41,P=0.001.髂总淋巴结阳性患者5年总生存率为21.2％.多因素分析显示,淋巴血管间隙浸润(OR=2.6,P=0.01)及腹主动脉旁淋巴结转移(OR=9.3,P＜0.01)均为早期宫颈癌髂总淋巴结转移患者5年生存率的独立影响因素.结论 早期宫颈癌髂总淋巴结转移率较低,盆腔其他淋巴结转移是其独立高危因素,而且髂总淋巴结转移患者预后较差.若术后病理显示髂总淋巴结转移患者,在补充放化疗时,建议采用调强适形放疗,同时建议其靶区勾画的范围上界达到腹主动脉旁.     

Prognostic factors and treatment outcome after radiotherapy in cervical cancer patients with isolated para-aortic lymph node metastases

Objective

The purpose of the present study was to evaluate treatment outcomes and prognostic factors in cervical cancer patients with isolated para-aortic lymph node (PALN) metastases. We especially tried to evaluate PALN factors such as size, site and number.

Methods

From August 1994 to December 2009, 40 cervical cancer patients with isolated PALN node metastases at initial diagnosis were selected for analysis. Patients underwent both extended field external beam and intracavitary brachytherapy. Fourteen patients received 5-fluorouracil and cisplatin (FP) and 16 patients received weekly concurrent cisplatin. Information of PALN, such as size, site, and number, was founded before PALN radiotherapy.

Results

The median follow-up time after primary treatment was 28.5 months (range, 2 to 213 months). The 3-year overall and progression-free survival rate after primary treatment was 44.3% and 31.3%, respectively. In multivariate analysis including tumor stage, performance status, and chemotherapy, FP regimen concurrent chemoradiotherapy was more effective than radiotherapy alone (p=0.030). The 3-year progression-free survival rate was 41.9% and 11.1% in patients with PALN numbers of ≤1 and ≥2, respectively (p=0.008). The 3-year progression-free survival rate was 42.1% and 19.2% in patients with PALN size of <1.5 cm and ≥1.5 cm, respectively (p=0.031).

Conclusion

The radiologic features of PALN, such as number or size, can be used to determine prognosis in PALN metastatic cervical cancer patients. Furthermore, FP regimen concurrent chemoradiotherapy was associated with better patient survival than radiotherapy alone. However, more studies are required to confirm possible different treatment outcomes between FP and weekly cisplatin regimens.     

早期胃癌的淋巴结转移规律及预后分析

目的 分析早期胃癌的临床病理特征与预后之间的关系及早期胃癌的淋巴结转移规律.方法 对1994年1月～2005年10月手术治疗并有完整资料的255例早期胃癌的临床病理学资料进行回顾性分析.结果 255例患者的总5年生存率为91.4%.单因素分析显示,肿瘤浸润深度、脉管瘤栓和区域淋巴结转移与患者术后生存率有关;而性别、年龄...     

肌层浸润性膀胱癌患者根治术后预后相关因素分析

目的:探讨肌层浸润性膀胱癌根治术预后相关因素。方法:回顾性分析156例腹腔镜下根治性膀胱全切除术及盆腔淋巴结清扫术后肌层浸润性膀胱癌患者生存数据,选择17种可能对预后产生影响的因素,采用Kaplan-Meier法及Cox比例风险模型统计分析。结果:单因素分析示年龄、肿瘤T分期、有无淋巴结转移、肾积水、是否侵犯输尿管下段、是否侵犯淋巴脉管、是否行新辅助化疗、术后辅助放化疗对患者预后的影响差异有统计学意义（P<0.05）。多因素分析示年龄（P<0.001）、肿瘤T分期（P=0.003）、淋巴结转移（P=0.031）、新辅助化疗（P=0.015）为肌层浸润性膀胱癌根治术预后影响因素。结论:年龄、肿瘤T分期、淋巴结转移为影响肌层浸润性膀胱癌根治术患者生存的独立危险因素。新辅助化疗是肌层浸润性膀胱癌根治术预后保护因素。     

Significance of Concurrent Chemoradiotherapy as Primary Treatment in Patients with Metastatic Cervical Cancer

(1) This study investigated the prognostic impact of tumor size in patients with metastatic cervical cancer. (2) Methods: Seventy-three cervical cancer patients in our institute were stratified into two groups based on distant metastasis: para-aortic lymph node metastasis alone (IIIC2) or spread to distant visceral organs with or without para-aortic lymph node metastasis (IVB) to identify primary tumor size and concurrent chemoradiotherapy. (3) Results: The overall survival (OS) for patients with a tumor >6.9 cm in size was significantly poorer than that for patients with a tumor ≤6.9 cm in the IVB group (p = 0.0028); the corresponding five-year OS rates in patients with a tumor ≤6.9 and >6.9 cm were 53.3% and 13.4%, respectively. In the multivariate analysis, tumor size and primary treatment were significantly associated with survival in metastatic cervical cancer. (4) Conclusions: Tumor size ≤6.9 cm and concurrent chemoradiotherapy as the primary treatment were favorable prognostic factors for patients with metastatic cervical cancer.     

系统的淋巴结清扫术在子宫内膜癌治疗决策中的价值及可行性分析

背景与目的：淋巴结清扫术在子宫内膜癌治疗中的价值一直有争议,国内多数医院仅对部分高危型子宫内膜癌患者行淋巴结活检或选择性盆腔淋巴结切除术,罕有妇科医生对子宫内膜癌行系统的盆腔淋巴结清扫＋腹主动脉旁淋巴结清扫。本文探讨系统的淋巴结清扫术在子宫内膜痛治疗决策中的价值以及手术的可行性。方法：回顾2005年1月-2008年7月在我院行系统的腹膜后淋巴结清扫术的128例子宫内膜癌,对其临床病理特点、淋巴结转移情况、术后治疗决策改变情况以及手术并发症进行分析。结果：128例患者中19例（14．8％）出现淋巴结转移,其中盆腔淋巴结转移15例（11．7％）,腹主动脉旁淋巴结转移11例（8．6％）,7例患者同时出现盆腔及腹主动脉旁淋巴结转移,4例患者仅有腹主动脉旁淋巴结转移。病理类型、组织学分化程度、肌层浸润深度以及淋巴血管间隙浸润与淋巴结转移相关（P〈0．05）。15例患者因淋巴结转移分期升级,术后需要辅以化疗和／或放疗;另50例中危、中高危早期患者因手术排除了子宫外转移免去术后辅助治疗。8例（6．3％）患者术后出现并发症,其中盆腔感染3例,阴道残端出血2例,不全性低位肠梗阻、深静脉血栓伴淋巴囊肿和腔隙性脑梗塞各1例。中位手术时间为150min．中位出血量为300mL,其中27例（21．1％）患者接受输血治疗。结论：在子宫内膜癌患者中行系统的淋巴结清扫足安全可行的,通过全面的手术分期可以明确淋巴结转移情况,准确提供预后相关信息,指导术后辅助治疗。     

Prognostic value of paraaortic lymph node metastases in patients with ductal adenocarcinoma of the pancreatic head

IntroductionThe role of paraaortic lymphadenectomy for cancer of the pancreatic head is controversial. The aim of this study is to analyze the prognostic role of paraaortic lymph node (PALN) metastases after resection for ductal adenocarcinoma of the pancreatic head.Materials and methodsA retrospective analysis of all patients, who underwent upfront resection for ductal adenocarcinoma of the pancreatic head at the Frankfurt University Hospital from 2011 to 2020 was performed. The primary endpoint was survival, according to the presence of PALN metastases.ResultsOut of 468 patients with pancreatic resection, 148 had an upfront resection for ductal adenocarcinoma. Of those, in 125 (85%) a paraaortic lymphadenectomy was performed. In 19 (15.2%) PALN metastases were detected. The estimated overall median survival after resection was 21.7 months (95% CI 18.8 to 26.4), the disease free survival 16 months (95% CI 12 to 18). Among the patients with lymph node metastases, PALN metastases had no significant influence on overall (18.9 versus 19 months, HR = 1.3, 95% CI 0.7 to 2.6, p = 0.392) or disease free survival (14 versus 10.7 months, HR = 1.7, 95% CI 0.9 to 3.2, p = 0.076). After adjusting for T-stage, N-stage, grade, resection margin, PALN metastases, and adjuvant therapy, only adjuvant therapy had a prognostic significance for overall survival (HR = 0.47, 95% CI 0.26 to 0.85, p = 0.013).ConclusionPatients with ductal adenocarcinoma of the pancreatic head and PALN metastases do not have inferior outcomes than those with regional lymph node metastases. Thus, positive PALN should not be considered a contraindication for resection.     

Cyclooxygenase-2 expression as a predictor of para-aortic lymph node recurrence in uterine cervical cancer

PURPOSE: The overexpression of cyclooxygenase-2 (COX-2) is associated with a worse prognosis and the development of distant metastases in cervical cancer. This matched-pair analysis examined whether COX-2 expression is associated with para-aortic lymph node (PALN) recurrence in uterine cervical cancer treated with radiotherapy (RT). METHODS AND MATERIALS: For this study, we matched 20 patients with PALN recurrence after definitive or postoperative RT by stage with 20 others who did not have PALN recurrence. Of the 20 patients with PALN recurrence, definitive or postoperative RT was performed in 11 and 9 patients, respectively. COX-2 expression was assessed immunohistochemically using a mouse monoclonal antibody on formalin-fixed paraffin-embedded tumor specimens taken before RT. A logistic regression model was used to predict for PALN recurrence. RESULTS: COX-2 was expressed in 28 (70%) of the 40 patients. The staining intensity was as follows: weak in 19 (47%), moderate in 6 (15%), and strong in 3 (8%) patients. The patients with PALN recurrence had much greater expression of COX-2 (17 patients, 85%) than did the control group (11 patients, 55%; p = 0.04). Strong staining intensity of COX-2 was seen only in the PALN recurrence group. The statistically significant factors associated with PALN recurrence were positive pelvic lymph nodes (odds ratio, 7.61; 95% confidence interval, 1.55-37.37; p = 0.01) and COX-2 expression (odds ratio, 1.47; 95% confidence interval, 1.04-2.09; p = 0.03). CONCLUSION: Our findings suggest that COX-2 overexpression in the initial tumor tissue might be associated with PALN recurrence after RT in cervical cancer patients.     

Preoperative prognostic variables and the impact of postoperative adjuvant therapy on the outcomes of Stage IB or II cervical carcinoma patients with or without pelvic lymph node metastases: an analysis of 891 cases

BACKGROUND: The purpose of this study was to investigate pretreatment variables that could predict prognosis and to evaluate the impact of postoperative adjuvant therapy on the outcomes of patients with Stage IB or II cervical carcinoma with or without pelvic lymph node metastases. METHODS: Eight hundred ninety-one patients with Stage IB or II cervical carcinoma who underwent radical hysterectomy and bilateral pelvic lymphadenectomy as primary treatment at a single institution were analyzed. Potential prognostic variables were studied. RESULTS: Among the variables that could be assessed before treatment, depth of cervical stromal invasion (determined by magnetic resonance imaging), clinical stage, tumor size, grade of differentiation, and DNA index (determined by flow cytometry) were independent predictors of outcome in multivariate analysis using a Cox regression model. Three distinct prognostic groups (low, intermediate, and high risk) were defined using these variables. Five-year recurrence free survival (RFS) rates for the low, intermediate, and high risk groups were 94.6%, 82.7%, and 62.3%, respectively (P = 0.0001), and overall survival (OS) rates were 98.4%, 84.5%, and 68.7%, respectively (P = 0.0001). Among patients with pelvic lymph node metastases who were free of parametrial extension, those who received postoperative chemotherapy or chemoradiotherapy had significantly better RFS (P = 0.017) and OS (P = 0.043) than those who received no adjuvant therapy. Among patients without pelvic lymph node metastases but at high risk of recurrence, those who received adjuvant radiotherapy had significantly better RFS (P = 0.015) and marginally improved OS (P = 0.087) compared with those who received no adjuvant therapy. CONCLUSIONS: A model containing assessable pretreatment variables for predicting the prognoses of patients with early stage cervical carcinoma was formulated. Subsets of patients for whom postoperative chemotherapy or radiotherapy might be beneficial were identified. The data from this retrospective review may be useful when future prospective trials of the treatment of early stage cervical carcinoma are designed.     

Surgical versus radiographic determination of para-aortic lymph node metastases before chemoradiation for locally advanced cervical carcinoma: a Gynecologic Oncology Group Study

BACKGROUND: Patients with cervical cancer who had negative para-aortic lymph nodes (PALNs) identified by pretreatment surgical staging were compared with patients who had only radiographic exclusion of PALN metastases before they received treatment with pelvic radiation and brachytherapy (RT) plus cisplatin (C)-based chemotherapy. METHODS: Patients who participated in 1 of 3 Phase III Gynecologic Oncology Group (GOG) trials (GOG 85, GOG 120, and GOG 165) and who were assigned randomly to receive either RT plus C or RT plus C combined with 5-fluorouracil with or without hydroxyurea comprised this retrospective analysis. Patients who had negative PALN status determined by surgical sampling (mandatory in GOG 85 and GOG 120 and optional in GOG 165) were compared with patients who had negative PALN status determined radiographically (GOG 165). RESULTS: Five hundred fifty-five patients underwent surgical PALN sampling (the S group), and 130 patients underwent radiographic evaluation only (the R group). Age, race, histology, and tumor grade were similar. Patients in the R group had better performance status (P < .01), less advanced stage (P = .023), and smaller tumor size (P = .004) compared with patients in the S group, although patients with stage III and IV disease in the S group had better 4-year progression-free survival (48.9% vs 36.3%) and overall survival (54.3% vs 40%) compared with patients in the R group. In multivariate analysis, the R group was associated independently with a poorer prognosis compared with the S group (for disease progression: hazard ratio [HR], 1.35, 95% confidence interval [95% CI], 1.01-1.81; for death: HR, 1.46, 95% CI, 1.08-1.99). CONCLUSIONS: Surgical exclusion (compared with radiographic exclusion) of positive PALNs in patients with cervical cancer who received chemoradiation (RT plus C-based chemotherapy) had a significant prognostic impact.     

Hyperfractionated radiotherapy with concurrent chemotherapy for para-aortic lymph node recurrence in carcinoma of the cervix

PURPOSE: To evaluate efficacy, toxicity, and patterns of relapse in patients treated with hyperfractionated radiotherapy (HFRT) with concurrent chemotherapy for para-aortic lymph node (PALN) recurrence of cervical carcinoma. METHODS AND MATERIALS: Between September 1997 and October 2000, 12 cervical carcinoma patients with isolated PALN recurrence who had previously received radical or postoperative radiotherapy were treated with HFRT and concurrent chemotherapy. The initial FIGO stage was Stage IB in 4 (33%) patients, Stage IIA in 2 (17%), and Stage IIB in 6 (50%). The radiation field encompassed the gross recurrent PALN with the superior margin at the upper end of the T12 body and the inferior margin between L5 and S1. The fractionated dose was 1.2 Gy in 2 daily fractions, and the median total dose was 60 Gy. The weekly concurrent chemotherapy consisted of paclitaxel in 11 patients and cisplatin in 1. The median number of cycles of chemotherapy was 5. RESULTS: The latent period to PALN recurrence from the time of initial treatment for all patients ranged from 2 to 92 months (median: 12 months). One month after treatment, the clinical tumor response evaluated was complete in 33% (4/12) and partial in 67% (8/12). The 3-year overall survival rate and median survival were 19% and 21 months, respectively. The latent period to PALN recurrence was the only significant prognostic factor; the median survival of patients who relapsed in < or =24 months from the initial treatment of cervical carcinoma was 13 months vs. 45 months for those relapsed at >24 months (p = 0.026). Grade 3-4 hematologic toxicity developed in 2 patients. Six (50%) patients experienced Grade 2 nausea. There were no late gastrointestinal or neurologic complications during the follow-up period. Subsequent distant metastases after PALN treatment developed in 58% (7/12). CONCLUSION: HFRT of 60 Gy to PALN with concurrent chemotherapy could be regarded as an effective treatment modality without significant acute or late toxicity. Patients with a latent period >24 months until PALN recurrence had a more favorable survival rate than those with a latent period 相似文献