Dreyer G
Department of Obstetrics and Gynaecology, University of Pretoria, P.O. Box 667, Pretoria 0001, South Africa.
Best Pract Res Clin Obstet Gynaecol. 2005 Aug;19(4):563-76. doi: 10.1016/j.bpobgyn.2005.02.007. Epub 2005 Mar 26.
Radical abdominal hysterectomy with pelvic lymph node dissection remains the treatment of choice for most patients with early-stage cervical cancer. The radicality and extent of lymph node dissection and parametrial resection should be tailored to tumour- and patient-related risk factors. Adjuvant therapy after radical surgery improves local control in high-risk patients and some intermediate-risk patients. The absolute indications for adjuvant therapy include multiple or macroscopically involved nodes, parametrial invasion and positive surgical margins. Adjuvant therapy may be given as chemoradiation or as radiotherapy alone, depending on risk assessment and expected morbidity. Primary chemoradiation is an equally effective alternative, but adjuvant surgery or finishing hysterectomy after pelvic radiation is not beneficial. Promising new developments include neo-adjuvant chemotherapy followed by surgery for bulky early-stage disease, tailoring radicality to reduce therapeutic morbidity and integrating minimal access surgical techniques into current treatment protocols.
根治性腹式子宫切除术加盆腔淋巴结清扫术仍是大多数早期宫颈癌患者的首选治疗方法。淋巴结清扫和宫旁组织切除的根治程度应根据肿瘤和患者相关风险因素进行调整。根治性手术后的辅助治疗可改善高危患者和部分中危患者的局部控制。辅助治疗的绝对指征包括多个或肉眼可见受累淋巴结、宫旁浸润和手术切缘阳性。辅助治疗可采用放化疗或单纯放疗，具体取决于风险评估和预期发病率。原发性放化疗是一种同样有效的替代方法，但盆腔放疗后进行辅助手术或完成子宫切除术并无益处。有前景的新进展包括对体积较大的早期疾病先进行新辅助化疗再行手术、根据情况调整根治程度以降低治疗相关发病率以及将微创外科技术融入当前治疗方案。
