Classe J M, Rauch P, Rodier J F, Morice P, Stoeckle E, Lasry S, Houvenaeghel G
Department of Oncological Surgery, Centre R. Gauducheau, Site Hôpital nord, Bd. J. Monod, 44805 Saint-Herblain Nantes, France.
Gynecol Oncol. 2006 Sep;102(3):523-9. doi: 10.1016/j.ygyno.2006.01.022. Epub 2006 Feb 28.
To evaluate the morbidity and therapeutic value of surgery after concurrent chemoradiotherapy and brachytherapy in a multicentric series of patients with advanced cervical cancer.
Patients with stage IB2 to IVA cervical cancer treated with concurrent chemoradiotherapy and pelvic radiotherapy followed by brachytherapy and surgery from seven participating French comprehensive cancer centers were enrolled. The surgical treatment consisted of a hysterectomy, which ranged from radical hysterectomy to anterior pelvic exenteration, and lymph node resection. Acute toxicity, pathological response, overall, and disease-free survival were assessed for each pathological response to therapy.
One hundred seventy-five patients were enrolled from September 1987 to June 2002. The median age was 44 years [27;75]. Patients distribution according to clinical classification was as follows: 41 stage IB2, 18 IIA, 77 IIB, 12 IIIA, 14 IIIB, and 13 IVA. Forty-six patients experienced 51 postoperative complications. Thirty-three patients experienced grade 2 morbidity (18.9%, 33/175), among whom 19 experienced urinary complications (57.5%, 19/175). No post treatment mortality was observed. Grade 3 toxicity rate was 6.9% (12/175). Pathological complete response rate was 38% (67/175). After a median follow-up of 36 months, overall survival and disease-free survival were significantly better in patients who had a pathological complete response to therapy than those who achieved a partial pathological response (P < 0.0001).
Surgery after concurrent chemoradiotherapy and brachytherapy for advanced cervical cancer leads to an acceptable morbidity. Furthermore, surgery allows evaluation of the pathological response to therapy and improves local control in the case of partial pathological response.
在多中心的晚期宫颈癌患者系列研究中，评估同步放化疗及近距离放疗后手术的发病率及治疗价值。
纳入来自七个参与研究的法国综合癌症中心，接受同步放化疗及盆腔放疗，随后进行近距离放疗及手术的IB2至IVA期宫颈癌患者。手术治疗包括子宫切除术（范围从根治性子宫切除术到前盆腔脏器清除术）及淋巴结切除术。对每种治疗的病理反应评估急性毒性、病理反应、总生存率及无病生存率。
1987年9月至2002年6月共纳入175例患者。中位年龄为44岁[27；75]。根据临床分类的患者分布如下：41例IB2期，18例IIA期，77例IIB期，12例IIIA期，14例IIIB期，13例IVA期。46例患者出现51例术后并发症。33例患者出现2级并发症（18.9%，33/175），其中19例出现泌尿系统并发症（57.5%，19/175）。未观察到治疗后死亡。3级毒性率为6.9%（12/175）。病理完全缓解率为38%（67/175）。中位随访36个月后，对治疗有病理完全缓解的患者的总生存率及无病生存率显著优于获得部分病理缓解的患者（P<0.0001）。
晚期宫颈癌同步放化疗及近距离放疗后手术导致的发病率可接受。此外，手术可评估治疗的病理反应，并在部分病理反应的情况下改善局部控制。
