Extent of surgical resection for early carcinoma of the uterine cervix]

124 patients suffering from early carcinoma of uterine cervix treated by total hysterectomy are reported. Fifty-five (44%) patients had carcinoma in situ (Stage 0), 62 (50%) had Stage Ia and 7 (5.6%) Stage Ib lesions. All were treated by total hysterectomy. The 5-year survival rate was 97.6%. The authors believe that early lesion of carcinoma of uterine cervix having involvement within 2 cm and invasion to a depth of not more than 5 mm are curable by total hysterectomy without lymphatic dissection.     

早期子宫平滑肌肉瘤治疗方式的研究进展

子宫平滑肌肉瘤(uterine leiomyosarcoma, uLMS)临床罕见。其临床表现缺乏特异性,多数uLMS通常在术中或术后经组织病理得以诊断。由于uLMS恶性程度高、侵袭性强,即便确诊时尚处临床早期,疾病复发转移率及患者死亡率仍然较高,预后不容乐观。现有循证医学数据表明,FIGO分期是其最重要的独立预后因子。因此,在这个讲求精准医学与个体化治疗的时代,应予不同期别uLMS以不同的治疗策略。对于I期uLMS而言,手术仍是首选的治疗方式,但在全子宫切除的同时是否应切除双侧卵巢及是否应行淋巴结清扫仍尚存争议;而其他疗法如化疗、放疗、免疫治疗等亦对I期uLMS作用不一。本文将综述I期uLMS的治疗方式,分析其临床应用现状与最新研究进展,以期为临床诊疗提供参考。     

Extent of lymphadenectomy and outcome for patients with stage I nonsmall cell lung cancer

BACKGROUND:

It is uncertain whether lymphadenectomy (LA) affects overall survival (OS) or disease‐free survival (DFS) rates for patients with stage I nonsmall cell lung cancer (NSCLC), as is the optimal number of lymph nodes that should be recovered.

METHODS:

There were 24,273 patients with stage I NSCLC diagnosed from 1992 to 2002 who were included in the Surveillance, Epidemiology, and End Results database and who underwent a definitive surgical procedure. Median follow‐up was 35 months.

RESULTS:

For the entire population, having LA was associated with an increase in the 5‐year OS rate from 41.6% to 58.4% (P<.0001) and in DFS from 58.0% to 73.09%, compared with not having LA. Outcome improved with increasing number of recovered lymph nodes, with a plateau at 11 or more lymph nodes. For patients diagnosed from 1998 to 2002 undergoing only N1 or only N2 dissections, LA was also associated with statistically significant improvements in OS in both groups and a significant difference and trend for improved DFS in the 2 groups, respectively. The maximum differences in both OS and DFS between those with no LA and those with LA occurred when 11 to 16 lymph nodes were removed for the former group or 7 to 10 lymph nodes for the latter group, respectively.

CONCLUSIONS:

LA was associated with increased rates of OS and DFS, compared with no LA. Our results also suggest the minimum number of recovered lymph nodes needed to see the maximum staging accuracy conferred by LA. Cancer 2009. © 2009 American Cancer Society.     

High-dose-rate intracavitary irradiation in the treatment of carcinoma of the uterine cervix: early experience with 84 patients

Eighty-four patients with previously untreated invasive carcinoma of the uterine cervix were treated by high-dose-rate intracavitary irradiation using a remotely controlled afterloading system (Ralstron) with or without external irradiation at the National Cancer Center Hospital, Tokyo, between 1977 and 1981. Survival rates and local control rates were comparable to those for 372 patients treated by low-dose-rate intracavitary irradiation with or without external irradiation from 1972 to 1981 at the hospital. The incidence of major complications was 5.1 and 2.4% for the patients treated by low-dose-rate intracavitary irradiation and by high-dose-rate irradiation, respectively. The results are comparable to those reported by other institutions. We have abandoned the conventional low-dose-rate intracavitary irradiation with the impression that the high-dose-rate remotely controlled afterloading system is a good alternative to the conventional one.     

Different strategies of treatment for uterine cervical carcinoma stage IB2-IIB

Uterine cervical cancer is the second most common gynecological malignancy. It is estimated that over 35% of tumors are diagnosed at locally advanced disease, stage IB2-IIB with an estimated 5-year overall survival of 60%. During the last decades, the initial treatment for these women has been debated and largely varies through different countries. Thus, radical concurrent chemoradiation is the standard of care in United Sated and Canada, and neoadjuvant chemotherapy followed by radical surgery is the first line of treatment in some institutions of Europe, Asia and Latin America. Until today, there is no evidence of which strategy is better over the other. This article describe the evidence as well as the advantages and disadvantages of the main strategies of treatment for women affected by uterine cervical cancer stage IB2-IIB.     

保留乳房手术在早期乳腺癌治疗中的应用

目的：研究规范病例的选择、手术的范围及术后辅助治疗的方式,使早期乳腺癌的保乳治疗取得良好的局部控制水平、生存率及生活质量。方法：1995年10月-2000年2月,对78例早期乳腺癌病例实施了保乳治疗。手术指征：肿瘤最大直径≥3cm,周围型肿块,年龄≤65岁,病人有保留乳房的意愿,乳房足够大,以保证术后有良好的外形。手术方式为肿块广泛切除加腋淋巴结清扫;肿块位于乳腺外上象限者,原发灶与腋窝行整块切除。术后常规行辅助放疗及化疗。结果：手术标本各个切缘的组织病理切片检查未发现肿瘤累及。13例为导管内癌,9例特殊型浸润性癌,56例为浸润性导管癌;8例患者腋淋巴结发现癌转移,中位淋巴结转移个数为3个（1-8）。中位随访时间22个月。尚无局部及区域复发的病例。有1例远处转移,转移部位是胸膜,手术至转移期间30个月。对40名保乳治疗满一年的病例行乳房外形的随访,两侧乳头水平高度相差＞3cm有7例（17.5%),两侧乳房下皱褶水平高度相差＞3cm有3例（7.5%),两侧乳头与胸骨中线距离相差＞1.5cm有2例（5%）。结论：规范的广泛切除、腋淋巴结清扫及术后辅助放疗是早期乳腺癌保乳治疗的关键措施,可使局部复发率降低;同时保乳治疗后大多数病例能够保持良好的乳房外形。     

FIGO stage IIIA carcinoma of the uterine cervix.

Between 1955 and 1988, 44 patients with FIGO Stage IIIA carcinoma of the cervix were treated with radiotherapy at The University of Texas M. D. Anderson Cancer Center. This represents only 3% of the 1473 Stage III cervical carcinoma patients treated at M. D. Anderson during this time period. The 5- and 10-year actuarial survival rates of patients with Stage IIIA disease were 37% and 34%, respectively. The actuarial pelvic disease control rate was 72% at 5 and 10 years. Of the 23 patients who experienced a recurrence of their disease, 10 had a recurrence in the pelvis only, 11 had distant metastases only, and two had recurrences in the pelvis and distantly. Two factors, parametrial disease extension and discontinuous involvement of the lower third of the vagina were important predictors of prognosis. The 5-year survival rate of 27 patients with parametrial involvement was 25% compared with 56% for the 17 patients without parametrial disease (p = 0.05). The 5-year survival rate of 13 patients with discontinuous ("skip") lesions in the lower third of the vagina was 15% compared with 48% for 31 patients who presented with direct extension of disease to the lower vagina (p = 0.05). This was because of a high rate of distant disease recurrence in patients with skip lesions since pelvic control rates were similar for both groups. No patient who presented with both parametrial extension and discontinuous vaginal involvement survived 5 years. In contrast, patients with lesions that extended directly from the cervix to involve the lower vagina without involving the parametrium had an excellent 5-year survival rate of 73%.     

Endometrial carcinoma stage I

Standard staging and therapeutic approach to endometrial cancer involves lymph node sampling (LNS) at the time of total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO). Lymphadenectomy prolongs time of surgery and increases the risk of morbidity; where other predictors are available, it may not contribute important supplementary information. 185/247 women with stage I endometrial carcinoma underwent the standard surgery while 62 underwent TAH+BSO. Recurrence and survival were monitored for a mean of 6.5 years and retrospectively reviewed: the rates for groups with and without known lymph node status were alike [13.5% (25/185) recurrence for the former and 12.9% (8/62) for the latter, and 5-year survival rates of 75.7% (140/185) for the former and 74.2 (46/62) for the latter]. Myometrial invasion and histological grade appeared to have been highly accurate predictors without lymph node information. Because information on histological grade is available early and is highly predictive, its use could be incorporated into a revised management algorithm for stage I endometrial cancer which would depend upon ensuring lymphadenectomy for women with low grade histopathology and omitting it for those with high grades on the grounds that no further information is necessary to act appropriately.     

Low stage invasive carcinoma of the uterine cervix stage I-IIA morphological prognostic factors

Histological material was reviewed from the 213 patients who had undergone radical surgery for carcinoma of the uterine cervix stage I and IIA between 1967 and 1981. Squamous carcinoma was found in 179 patients (84.7%). In 39 patients (18%) there were lymph node metastases and in nine (4.2%) tumor spread into the parametrium. Vaso-invasion was present in 49 patients (22%). Prognostic factors were studied by Cox's regression analysis. Lymph node metastases and vaso-invasion were both found to be significantly related to survival rate (P = 0.0001 and P = 0.0008). Stage, cell type, differentiation and invasion depth were of no prognostic importance.     

早期鼻咽癌肿瘤容积对综合治疗影响的探讨

目的：探讨早期鼻咽癌肿瘤容积在综合治疗中的影响价值。方法：将60例经病理确诊的初治早期鼻咽癌患者随机分为对照组（A组）和治疗组（B组）。所有鼻咽癌患者行CT模拟定位,用计算机软件系统计算出大体肿瘤容积（GTV）。A组给予单纯常规放射治疗,B组采用常规分割放射治疗和PF方案同步化疗。结果：原发灶完全缓解率A组80．0％,B组96．7％,Х^2=4．043,P=0．044。A组Ⅰ、Ⅱ级与Ⅲ、Ⅳ级急性皮肤反应分别为90．0％和10．0％,B组分别为80．0％和20．0％,Х^2=1．176,P=0．278;A组急性黏膜炎反应分别为83．3％和16．7％,B组分别为66．7％和33．3％,Х^2=2．222,P=0．136。结论：对GTV〉25cm^3的早期鼻咽癌同步放化疗是安全可行的,其远期并发症,如严重张口困难和后组颅神经损伤有待进一步观察和随访。     

早期子宫内膜癌盆腔及腹主动脉旁淋巴结清扫术的作用

关于子宫内膜癌的手术范围和模式至今尚无统一的意见,尤其是对系统性盆腔及腹主动脉旁淋巴结清扫的必要性和清扫范围仍然存在较大争议。早期低危子宫内膜癌可以通过前哨淋巴结检测进行局部淋巴结选择性切除,从而降低手术风险。但在中-高危子宫内膜癌患者中,腹膜后淋巴结活检不能代替系统性盆腔及腹主动脉旁淋巴结清扫。腹主动脉旁淋巴结清扫术不会增加重大脏器损伤、二次手术及重度肠梗阻的风险。系统性盆腔及腹主动脉旁淋巴结清扫可以提高子宫内膜癌患者的生存率并改善预后。     

放射性粒子125I植入治疗12例早期肾癌的临床观察

目的:评价CT引导下瘤体内125I粒子植入治疗早期肾癌的可行性、安全性及其疗效.方法:对12例肾癌患者的15个病灶在CT引导下行瘤体内125I粒子植入治疗,植入术后立即CT扫描观察粒子在瘤体内的分布,术后随访观察有无并发症发生.结果:12例患者均顺利完成手术,平均时间43(30～50) min.单个瘤体内植入125I粒子数为1～19粒(平均8粒).术后6个月CT扫描显示粒子分布满意,15个病灶中4个消失,7个明显缩小,3 个病灶稳定,1个进展.1例孤立肾患者术后3个月发现肉眼血尿,经保守治疗后消失.12例患者未见治疗相关的放射损伤.平均随访36(6～52)个月,1例术后13个月死于心肌梗死,2例术后18和22个月死于多发肺转移.余9例正常生存.结论:CT导引下125I粒子植入治疗对早期肾癌是一种可供选择的安全、有效治疗方法.     

Possibilities in the conservative treatment of patients with early forms of uterine cancer

Organ-saving surgery was used in 134 patients with early cervical cancer (high amputation with a lancet-98 and cryotherapy-36 cases). The efficiency of the procedure was verified by morphological examination of samples obtained from the operation site at certain periods after primary treatment. The results of surgical treatment and hormonotherapy of early endometrial cancer (66 and 17 cases, respectively) are presented. Sparing methods may be used for treatment of early cancer of the uterus. Due to their application, menstrual, sexual and reproductive functions are preserved.     

Clinical stage I carcinoma of the uterine cervix value of preoperative magnetic resonance imaging in assessing parametrial invasion

AIMS AND BACKGROUND: The purpose of this prospective study was to assess the efficacy of different MR imaging techniques in the evaluation of parametrial tumor invasion in patients with early stage cervical cancer. METHODS: A total of 73 consecutive patients, clinically considered to have invasive tumor (<3 cm in diameter) confined to the cervix, underwent MR imaging studies at 1 T, according to the following protocol: fast spin-echo (FSE) T2-weighted, gadolinium-enhanced SE T1-weighted, and fat-suppressed gadolinium-enhanced SE T1-weighted sequences. Images obtained with each sequence were evaluated for parametrial invasion with the use of histopathologic findings as the standard of reference. RESULTS: In the assessment of tumor infiltration of the parametrium, with FSE T2-weighted images accuracy was 83%, with SE T1-weighted gadolinium-enhanced images was 65%, and with SE T1-weighted gadolinium-enhanced fat-suppressed images was 72%. The difference between the accuracy rate achieved with FSE T2-weighted images and those obtained with the other two MR sequences was statistically significant (P <0.05). The high negative predictive value (95%) for the exclusion of parametrial tumor invasion was the principal contributor to the staging accuracy obtained with FSE T2-weighted imaging. CONCLUSIONS: Unenhanced FSE T2-weighted imaging is a reliable method for determining the degree of tumor invasion in patients with early stage cervical cancer. Our data suggest that contrast-enhanced sequences, even with the use of the fat suppression technique, have limited value in assessing tumor extension.     

362例早期鼻咽癌单纯放疗疗效分析

目的 分析早期鼻咽癌患者单纯放疗的长期疗效及不同T与N分期对预后影响.方法 搜集接受单纯放疗的362例早期(T1～T2 N0～1M0期,1992年福州分期)鼻咽癌初治患者的临床资料做回顾分析.结果 中位随访70个月,全组病例5年总生存率为85.0%.T1N0、T2N0和T1N1期5年总生存率分别为96.6%、91.3%和85.8%(χ2=3.83,P＞0.05),T2N1期的(73.1%)比前3个期别明显减低(χ2=30.0,P＜0.05),而4个期别的5年无局部复发生存率和无区域复发生存率均无差异.T1N0、T2N0和T1N1期5年无远处转移生存率分别为94.9%、97.5%和95.6%(χ2=0.53,P＞0.05),T2N1期的(81.2%)比前3个期的明显减低(χ2=26.6,P＜0.05).结论 单纯常规放疗对T1N0、T2N0和T1N1期患者可获得满意疗效.T2N1M0期的疗效明显差于前3个期别,其治疗失败的主要原因是远处转移.针对T2N1M0期筛选容易发生远处转移的个体给予放化综合治疗是下一步研究方向.     

早期子宫肉瘤的术后放疗临床分析

目的：探讨早期子宫肉瘤术后辅助故疗对局部控制率和生存率的影响，方法：回顾性分析我院1969年4月～1999年10月收治的子宫肉癌76倒的临床资料，Ⅰ期49例，Ⅱ期27例．其中单纯手术组34例，术后放疗组42例。结果：二年和五年的无瘤生存率，单纯手术组件别为38．2％和26．5％，本后放疗组为69.O％和57.1％．二年和五年盆腔局部复发．手术组分别为52.9％和64.7％．术后放疔组分别为26．2％和28．6％．二年和五年总的生存率手术组为83．4％和47．0％，术后放疗组为833％和69.0％。结论：术后放疗可明显提高局部控制率．减少远处复发，进而提高无瘤生存率和五年生存率。