Jackson K S, Fankam E F, Das N, Naik R, Lopes A D, Godfrey K A, Hatem M H, Branson A N, Taylor W T
Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead NE9 6SX, United Kingdom.
Int J Gynecol Cancer. 2006 Jan-Feb;16(1):283-7. doi: 10.1111/j.1525-1438.2006.00370.x.
It is essential that any patient with resected vulval cancer and significant nodal disease receive optimal adjuvant treatment with radiation. Adequate radiotherapy for such patients with unilateral positive groin nodes has not been defined. Whether both groins and pelvic sidewalls should be irradiated or only the affected (node positive) side remains unclear. From our registry, we identified all patients with primary, previously untreated squamous cell carcinoma of the vulva undergoing bilateral inguinofemoral lymphadenectomy (superficial and deep nodes) and having unilaterally positive groin nodes treated with unilateral groin and pelvic radiotherapy (44 Gy in 22 fractions). Clinical and pathologic records were reviewed to identify the anatomical site and timing of recurrences in these patients and determine whether unilateral groin and pelvic irradiation was sufficient for disease control on the node-negative side. From 1983 to 2002, 20 patients with unilateral positive nodes treated with unilateral groin and pelvic irradiation were identified. Nineteen patients were classed as having FIGO stage III disease and one as FIGO stage IV due to involvement of the rectal mucosa. There were nine patients with disease recurrences in this group (45%). The disease-free interval ranged from 4 to 31 months (median time to recurrence, 9 months). All nine patients had local or regional failures, the most common site being the ipsilateral groin (six of nine patients). One patient was also found to have distant metastases. There were no recurrences noted in the contralateral (nonirradiated) groin or pelvic sidewall. Recurrence was generally fatal. Eight of the nine patients subsequently died of their disease. The ninth patient died of another cause. There was a high incidence of regional failure after unilateral groin and pelvic radiotherapy, but there were no recurrences on the nonirradiated, node-negative side. Although a small series, we speculate that there is no apparent disadvantage to administering unilateral adjuvant radiotherapy for unilaterally positive groin nodes and encourage further studies in order to more confidently determine whether the tendency observed in our center holds true.
任何接受过外阴癌切除术且伴有显著淋巴结疾病的患者接受最佳的放射辅助治疗至关重要。对于此类单侧腹股沟淋巴结阳性的患者，充足的放疗方案尚未明确。双侧腹股沟和盆腔侧壁是否均应接受照射，还是仅照射患侧（淋巴结阳性侧）仍不明确。通过我们的登记系统，我们确定了所有原发性、未经治疗的外阴鳞状细胞癌患者，这些患者接受了双侧腹股沟股淋巴结清扫术（浅表和深部淋巴结），且单侧腹股沟淋巴结阳性，并接受了单侧腹股沟和盆腔放疗（22次分割，共44 Gy）。回顾临床和病理记录，以确定这些患者复发的解剖部位和时间，并确定单侧腹股沟和盆腔照射对于淋巴结阴性侧的疾病控制是否足够。1983年至2002年期间，确定了20例接受单侧腹股沟和盆腔照射的单侧淋巴结阳性患者。19例患者被归类为FIGO III期疾病，1例因直肠黏膜受累被归类为FIGO IV期疾病。该组中有9例患者疾病复发（45%）。无病生存期为4至31个月（复发的中位时间为9个月）。所有9例患者均有局部或区域复发，最常见的部位是同侧腹股沟（9例患者中的6例）。还发现1例患者有远处转移。对侧（未照射）腹股沟或盆腔侧壁未发现复发。复发通常是致命的。9例患者中有8例随后死于疾病。第9例患者死于其他原因。单侧腹股沟和盆腔放疗后区域复发的发生率较高，但未照射的淋巴结阴性侧未出现复发。尽管样本量较小，但我们推测，对于单侧腹股沟淋巴结阳性患者给予单侧辅助放疗没有明显的劣势，并鼓励进一步研究，以便更有信心地确定我们中心观察到的趋势是否成立。
