Kovalic J J, Perez C A, Grigsby P W, Lockett M A
Radiation Oncology Center, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110.
Int J Radiat Oncol Biol Phys. 1991 Sep;21(4):905-10. doi: 10.1016/0360-3016(91)90728-m.
This is a retrospective study of 635 consecutively treated patients with FIGO Stage IIB or IIIB carcinoma of the uterine cervix. All patients were treated definitively with radiation therapy. The effect of volume of disease on outcome was studied. The 5-, 10-, and 15-year disease-free survivals (DFS) for the 346 Stage IIB patients were 64%, 61%, and 58%, respectively. Corresponding DFS for the 289 Stage IIIB patients were 40%, 38%, and 34%, respectively. The presence of bilateral parametrial invasion did not alter the 10-year DFS in Stage IIB patients (61% vs 64%, p = 0.60) but did decrease it in Stage IIIB patients (34% vs 50%, p = 0.006). Patients with both Stage IIB and IIIB cancers and central bulky disease (greater than or equal to 5 cm in diameter) had decreased DFS when compared to those without central bulky disease. Stage IIB patients with the lateral half of the parametrium involved had a decreased 10-year DFS in comparison with medial half involvement (52% vs 68%, p = 0.004). The total pelvic failure rate was 23% for Stage IIB and 41% for Stage IIIB patients. Central bulkiness increased the pelvic failure rate by about 11% for all patients. Bilateral parametrial disease increased the pelvic failure rate in Stage IIIB patients but not in patients with Stage IIB disease. The total pelvic failure rate for Stage IIB patients was greater in those whose disease extended into the lateral parametrium. Multivariate analysis was done using stage, lateral pelvic wall dose, parametrial disease, central bulkiness, age, and total dose to point A as variables. With local control as the endpoint, only stage (IIB vs IIIB) was significant (p = 0.008). Using DFS as the endpoint, stage (p = 0.0001) and central bulkiness of tumor (p = 0.026) were significant. Complications were not increased in patients with bulky or bilateral disease. We conclude that there is justification for subdividing FIGO Stage IIIB patients into those with unilateral or bilateral disease; however, these data do not support such a division for FIGO Stage IIB patients. These latter patients would be better analyzed with reference to medial versus lateral parametrial extension because of the difference in pelvic control and survival.
这是一项对635例连续接受治疗的国际妇产科联盟（FIGO）IIB期或IIIB期子宫颈癌患者的回顾性研究。所有患者均接受了根治性放射治疗。研究了疾病体积对预后的影响。346例IIB期患者的5年、10年和15年无病生存率（DFS）分别为64%、61%和58%。289例IIIB期患者相应的DFS分别为40%、38%和34%。双侧宫旁浸润的存在并未改变IIB期患者的10年DFS（61%对64%，p = 0.60），但在IIIB期患者中使其降低（34%对50%，p = 0.006）。与无中心大块病灶的患者相比，IIB期和IIIB期且有中心大块病灶（直径大于或等于5 cm）的患者DFS降低。IIB期宫旁外侧半受累的患者与内侧半受累的患者相比，10年DFS降低（52%对68%，p = 0.004）。IIB期患者的总盆腔失败率为23%，IIIB期患者为41%。中心大块病灶使所有患者的盆腔失败率增加约11%。双侧宫旁疾病增加了IIIB期患者的盆腔失败率，但未增加IIB期患者的盆腔失败率。疾病延伸至宫旁外侧的IIB期患者的总盆腔失败率更高。以分期、盆腔侧壁剂量、宫旁疾病、中心大块病灶、年龄和A点总剂量为变量进行多因素分析。以局部控制为终点，仅分期（IIB期对IIIB期）具有显著性（p = 0.008）。以DFS为终点，分期（p = 0.0001）和肿瘤中心大块病灶（p = 0.026）具有显著性。大块或双侧疾病患者的并发症并未增加。我们得出结论，有理由将FIGO IIB期患者细分为单侧或双侧疾病患者；然而，这些数据不支持对FIGO IIB期患者进行这种划分。由于盆腔控制和生存率的差异，后一类患者最好根据宫旁内侧与外侧延伸情况进行分析。
