Maruyama Y, Donaldson E, van Nagell J R, Yoneda J, Gallion H H, Powell D, Kryscio R J
Department of Radiation Medicine, University of Kentucky Medical Center, Lexington 40536-0084.
Gynecol Oncol. 1991 Dec;43(3):252-9. doi: 10.1016/0090-8258(91)90030-9.
Twenty-seven patients with operable Stage II cervical cancer with a mean diameter tumor of 8.0 cm were studied in a feasibility study using preoperative 252Cf implants plus whole-pelvis radiation to 45 Gy followed by extrafascial total abdominal hysterectomy and bilateral salpingo-oophorectomy 4 to 6 weeks later. Hysterectomy specimens were studied by a set protocol. With the protocol used, 13/27 (51%) specimens and abdominal stagings were negative for residual tumor. The survival rate for the patients with negative findings was 93% at 5 years. In 14/27 (49%) patients the specimens were positive for residual tumor. In contrast, the 5-year survival rate for this group was 46% (P less than 0.001). In these patients several interrelated factors were determined to be of importance, i.e., (1) tumor size greater than 8 cm in maximum diameter, (2) positive or negative residual tumor status, and (3) total dose of radiation given. Survival was lower for larger tumors and specimens were more likely to show residual tumor. A lower treatment dose led to more positive specimens, as well as to poorer survival. While the patients with Stage II disease fared very well when negative specimens were found, further prospective studies of the appropriate treatment for those with positive tumor specimens are needed.
在一项可行性研究中，对27例可手术的II期宫颈癌患者进行了研究，这些患者肿瘤平均直径为8.0厘米。研究采用术前252锎植入加全盆腔放疗至45戈瑞，然后在4至6周后行筋膜外全腹子宫切除术及双侧输卵管卵巢切除术。子宫切除标本按既定方案进行研究。按照所使用的方案，13/27（51%）的标本及腹部分期未见残留肿瘤。检查结果为阴性的患者5年生存率为93%。14/27（49%）的患者标本有残留肿瘤阳性。相比之下，该组患者的5年生存率为46%（P<0.001）。在这些患者中，确定了几个相互关联的重要因素，即：（1）最大直径大于8厘米的肿瘤大小；（2）残留肿瘤状态为阳性或阴性；（3）给予的放疗总剂量。较大肿瘤患者的生存率较低，且标本更有可能显示残留肿瘤。较低的治疗剂量导致更多阳性标本以及较差的生存率。虽然II期疾病患者在标本为阴性时预后很好，但仍需要对肿瘤标本为阳性的患者的适当治疗进行进一步的前瞻性研究。
