根治性同步放化疗前淋巴结清扫在局部晚期宫颈癌诊疗中的意义

宫颈癌是威胁女性健康的第四大肿瘤,分期主要基于临床检查。2018年10月国际妇产科联盟(FIGO对宫颈癌分期进行了修改,强调了盆腔及腹主动脉旁淋巴结的转移情况。对于根治性同步放化疗的患者,淋巴结转移与放疗肿瘤控制率密切相关。由于腹主动脉旁淋巴结转移的情况决定了是否扩大放疗照射野,放疗对于较大的淋巴结控制效果不理想,因此在根治性放化疗前手术评估淋巴结情况、切除增大的淋巴结,有助于分期及减瘤,进行个体化的治疗。但手术分期为有创操作,存在相关风险,可能推迟放疗起始时间,缺乏前瞻性的随机对照研究,此治疗方式并未被广泛认可。综述根治性放化疗前手术清扫淋巴结分期的相关文献。

Pretreatment Lymph Node Staging in Locally Advanced Cervical Cancer

Cervical cancer is a major world health problem and the fourth most common cancer for women, its staging is mainly based on clinical examination. The International Federation of Gynecology and Obstetrics (FIGO) released a revised new staging system of cervical cancer in October 2018, which emphasizes the metastatic status of pelvic and para-aortic lymph node. Pelvic and para-aortic lymph nodes metastasis is a main risk factor of failure in concurrent chemoradiation therapy (CCRT) in cervical cancer. Due to the key role of para-aortic lymph node status in determining the radiation field and unsatisfactory control rate in large lymph node, a surgical staging of lymph node dissection before chemoradiation therapy is utilized to personalize and optimize the effect of tumor reduction and determine the field of radiation. However, surgical staging may cause perioperative complications and delay of the radiation. Due to the lack of prospective randomized controlled trials, there is no consensus on surgical staging in cervical cancer. We review the literature of surgical staging before CCRT in patients with locally advanced cervical cancer.