原发浸润性阴道癌放疗预后分析

目的 分析原发浸润性阴道癌的临床特点、治疗方法及预后因素.方法 回顾分析1980-2007年本科治疗的83例原发浸润性阴道癌患者资料,其中体外照射+腔内后装治疗65例,单纯后装治疗7例,单纯外照射11例;31例联合化疗(8例经髂内动脉插管的导管化疗,16例静脉化疗,7例同步化放疗).FIGO分期Ⅰ期19例,Ⅱ期31例,Ⅲ期25例,Ⅳ期8例.病理类型鳞癌53例,腺癌22例,腺鳞癌2例,未分化癌1例,透明细胞癌2例,浆液性乳头状腺癌3例.肿瘤分化程度高分化39例,中+低分化44例.总中位照射剂量为75 Gy,剂量≥70 Gy者51例.结果 随访率为89%,随访满3、5年者分别为35、31例.总3、5年生存率分别为51%、42%.单因素分析显示FIGO分期(x2=11.30,P=0.010)、病理类型(x2=5.76,P=0.016)、病理分级(x2=5.76,P=0.016)、肿瘤大小(x2=4.81,P=0.020)、肿瘤部位(x2=23.50,P=0.000)、是否腔内联合体外照射(x2=29.76,P=0.000)对预后有影响,而多因素分析仅显示FIGO分期(x2=5.93,P=0.015)、肿瘤大小(x2=8.48,P=0.004)对预后有影响.10例患者出现严重放射晚期副反应.28例患者治疗失败后再治疗的3年生存率为14%.结论 早期原发浸润性阴道癌放疗有效,临床分期和肿瘤大小对预后有影响,化疗联合放疗的意义还需进一步研究.

Prognostic factors for primary vaginal carcinoma managed with radiotherapy : a study of 83 cases

Objective To analyze the clinical and histopathologic characteristics and prognostic factors for primary carcinoma of the vagina managed with radiotherapy at a single institution . Methods Eighty-three patients with primary vaginal carcinoma were treated with definitive radiation therapy between 1980 and 2007 were retrospectively analyzed. Radiotherapy was delivered with external beam radiation alone in 11 patients, intracavitary after-loading radiation alone in 7 patients, and external beam combined with After-loading radiation in 65 patients. The median radiation dose was 75 Gy. Fifty-one patients received more than 75 Gy. Thirty-one patients received combined chemotherapy. Of them, 16 received intravenous neoadjuvant or adjuvant chemotherapy, 8 received intra-arterial chemotherapy and 7 received concomitant chemotherapy. Patients were staged acoording to FIGO staging system. Nineteen patients had stage Ⅰ ;31 had stage Ⅱ, 25 had stage Ⅲ and 8 had stage Ⅳ diseases. Fifty-three patients had squamous cell carcinoma, 22 had adenocarcinoma, 2 had adenosquamous cell carcinoma,3 had papillary serous carcinoma,2 had clear-cell carcinoma and 1 had undifferentiated carcinoma. Thirty-nine patients had grade 1 and 44 had grade 2 and/or grade 3 diseases. Results The follow-up rate was 89%. Thirty-five and 31 patients had minimum followed-up time of 3 and 5 years respectively. The 3-and 5-year overall survival rates were 51% and 42% respectively. Univariate analysis showed that FIGO stage ( x2 = 11.30,P= 0. 010), histopathology type (x2=5.76,P=0.016),pathologic grade (x2=5.76,P=0.016), tumor size (x2=4.81,P=0. 020), tumor site ( x2=23.50,P =0. 000), external beam combined with intracavitary irradiation ( x2 =29. 76,P =0. 000) correlated with overall survival rate. Cox multivariate analysis showed only FIGO stage ( x2 = 5.93, P = 0. 015 ) and tumor size ( x2 = 8.48, P= 0. 004 ) were independent prognostic factors affecting overall survival. Serious complications were developed in 12% ( 10/83 ) of the patients. One patient suffered from vesicovaginal fistula and 3 from rectovaginal fistula. Twenty-eight patients had local or distant relapses, and the 3-year overall survival rate was 14% after salvage therapy. Conclusions Radiotherapy is effective for early stage primary vaginal carcinoma. FIGO stage and tumor size were independent prognostic factors affecting overall survival. The role of chemotherapy for advanced disease needs further study.