Busch M, Wagener B, Dühmke E
Clinic for Radiotherapy and Radiation Oncology, Ludwig Maximilians University, Munich, Germany.
Adv Ther. 1999 Mar-Apr;16(2):89-100.
From 1953 to 1978, definitive radiotherapy for carcinoma of the vulva without surgery was used as a standard therapy at a university hospital in Germany. We retrospectively reviewed the records of 170 patients treated mainly with electron-beam radiation to the vulva and Co-60 to the inguinal lymph nodes. Total doses to the vulva ranged from 6 to 90 Gy. A 30-year retrospective follow-up was accomplished. Tumor and node classification, tumor location, and parity were significant independent factors affecting survival. Actuarial survival was 52% for women with T1 disease, 25% for T2 disease, 10% for T3 tumors, and 0% for T4 tumors; survival with N0 tumors was 39% versus 13% with N2 lesions. Tumors of the labia minora were associated with a better survival rate (40.8% at 5 years) than were tumors at other locations (15%-21% at 5 years). Patients with zero to three children had significantly better results (32% at 5 years) than patients with four to seven children (11%). A dose of 60 Gy did not produce better long-term survival rates compared with lower doses, perhaps because low electron energy missed microscopic disease in deep vulvar tissues. On the basis of this review, patients with vulvar carcinoma should have at least a complete tumor resection. The therapeutic window between tumor control probability and the normal tissue complication rate in nonresected patients is too narrow: local recurrences are quite frequent with lower dose schedules, and survival rates are very poor, whereas complication rates are high with radical dose schedules that nevertheless provide acceptable cure rates.
1953年至1978年期间，德国一家大学医院将不进行手术的外阴癌根治性放疗用作标准治疗方法。我们回顾性分析了170例主要接受外阴电子束放疗及腹股沟淋巴结钴-60放疗患者的病历。外阴的总剂量范围为6至90 Gy。完成了30年的回顾性随访。肿瘤和淋巴结分类、肿瘤位置及产次是影响生存的重要独立因素。T1期疾病患者的精算生存率为52%，T2期为25%，T3期肿瘤为10%，T4期肿瘤为0%；N0期肿瘤患者的生存率为39%，而N2期病变患者为13%。小阴唇肿瘤的生存率（5年时为40.8%）高于其他部位的肿瘤（5年时为15%-21%）。子女数为零至三个的患者结果（5年时为32%）明显优于子女数为四至七个的患者（11%）。与较低剂量相比，60 Gy的剂量并未产生更好的长期生存率，这可能是因为低能量电子未能照射到外阴深部组织中的微小病灶。基于这项回顾，外阴癌患者应至少进行完整的肿瘤切除。未切除患者的肿瘤控制概率与正常组织并发症发生率之间的治疗窗口过窄：较低剂量方案时局部复发相当常见，生存率很差，而根治性剂量方案时并发症发生率很高，不过治愈率尚可接受。
