Perez C A, Fox S, Lockett M A, Grigsby P W, Camel H M, Galakatos A, Kao M S, Williamson J
Radiation Oncology Center, Mallinckrodt Institute of Radiology, St. Louis, MO 63108.
Int J Radiat Oncol Biol Phys. 1991 Sep;21(4):885-98. doi: 10.1016/0360-3016(91)90726-k.
This is a retrospective analysis of 1211 patients with histologically proven invasive carcinoma of the uterine cervix with a minimum follow-up of 3 years treated with irradiation alone. The pelvic failure rates by stage were 9.6% for IB, 18.6% for IIA, 23% for IIB, 41% for III, and 75% for Stage IVA disease. External beam and intracavitary irradiation doses to point A and pelvic lymph nodes were calculated. In patients with Stage IB and IIA disease there was no significant correlation between doses to these points and pelvic tumor control. In Stage IIB doses of less than 6000 cGy to point A correlated with a high pelvic failure rate (8 of 12, 66.7%) in contrast to doses of 6000 to 9000 cGy (61 of 261, 23.4%) or higher than 9000 cGy (10 of 74, 13.5%) (p less than or equal to 0.01). In Stage III the pelvic failure rate with doses below 6000 cGy to point A was 72% (18 of 25) compared to 39% (71 of 180) for 6000 to 9000 cGy or 35% (27 of 77) with doses above 9000 cGy (p less than or equal to 0.01). TDF calculation of doses was carried out. In Stage IB and IIA there was no significant correlation between TDF to point A and probability of pelvic recurrence. In Stage IIB with TDF below 135, the pelvic recurrence rate was 41.6% (20 of 48) compared to 20% (61 of 305) with higher TDF (p less than or equal to 0.01). In Stage III the pelvic failure rate was 51% with TDF below 160 (70 of 136) in comparison with 29.5% (46 of 156) with higher TDF (p less than or equal to 0.01). Grade 2 sequelae of therapy were noted in about 10% of the patients and grade 3 in 4.7% of patients with Stage IB (18 of 384), 10.2% (12 of 128) with Stage IIA, 9.3% (33 of 353) with Stage IIB, and 8.2% (24 of 293) with Stage III disease. Doses from external beam and intracavitary irradiation to the rectum or the bladder neck were calculated. The actuarial incidence of major rectal or rectosigmoid sequelae was 2% to 4% with doses to the rectum of 6000 to 8000 cGy, 7% to 8% with 8000 to 9500 cGy, and 13% with doses higher than 9500 cGy (p less than or equal to 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
这是一项对1211例经组织学证实为子宫颈浸润癌且仅接受放疗治疗、最短随访3年的患者的回顾性分析。各期的盆腔失败率为：IB期9.6%，IIA期18.6%，IIB期23%，III期41%，IVA期75%。计算了体外照射及腔内照射至A点和盆腔淋巴结的剂量。在IB期和IIA期患者中，这些部位的剂量与盆腔肿瘤控制之间无显著相关性。在IIB期，A点剂量低于6000 cGy时盆腔失败率较高（12例中的8例，66.7%），相比之下，6000至9000 cGy时为（261例中的61例，23.4%），高于9000 cGy时为（74例中的10例，13.5%）（p≤0.01）。在III期，A点剂量低于6000 cGy时盆腔失败率为72%（25例中的18例），6000至9000 cGy时为39%（180例中的71例），高于9000 cGy时为35%（77例中的27例）（p≤0.01）。进行了剂量的TDF计算。在IB期和IIA期，A点的TDF与盆腔复发概率之间无显著相关性。在IIB期，TDF低于135时盆腔复发率为41.6%（48例中的20例），TDF较高时为20%（305例中的61例）（p≤0.01）。在III期，TDF低于160时盆腔失败率为51%（136例中的70例），TDF较高时为29.5%（156例中的46例）（p≤0.01）。约10%的患者出现2级治疗后遗症，IB期患者中有4.7%（384例中的18例）、IIA期患者中有10.2%（128例中的12例）、IIB期患者中有9.3%（353例中的33例）、III期患者中有8.2%（293例中的24例）出现3级治疗后遗症。计算了体外照射及腔内照射至直肠或膀胱颈的剂量。直肠或乙状结肠主要后遗症的精算发病率在直肠剂量为6000至8000 cGy时为2%至4%，8000至9500 cGy时为7%至8%，高于9500 cGy时为13%（p≤0.01）。（摘要截断于250字）
