Cetina Lucely, Garcia-Arias Alicia, Candelaria Myrna, Cantú David, Rivera Lesbia, Coronel Jaime, Bazan-Perkins Blanca, Flores Vladimir, Gonzalez Aaron, Dueñas-González Alfonso
Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México/INCan, Mexico City, México.
World J Surg Oncol. 2009 Feb 16;7:19. doi: 10.1186/1477-7819-7-19.
A current paradigm in the treatment of cervical cancer with radiation therapy is that intracavitary brachytherapy is an essential component of radical treatment. This is a matched retrospective comparison of the results of treatment in patients treated with external beam chemoradiation (EBRT-CT) and radical hysterectomy versus those treated with identical chemoradiation followed by brachytherapy.
In this non-randomized comparison EBRT-CT protocol was the same in both groups of 40 patients. In the standard treated patients, EBRT-CT was followed by one or two intracavitary Cesium (low-dose rate) applications within 2 weeks of finishing external radiation to reach a point A dose of at least 85 Gy. In the surgically treated patients, radical hysterectomy with bilateral pelvic lymph node dissection and para-aortic lymph node sampling were performed within 7 weeks after EBRT-CT. Response, toxicity and survival were evaluated.
A total of 80 patients were analyzed. The patients receiving EBRT-CT and surgery were matched with the standard treated cases. There were no differences in the clinicopathological characteristics between groups or in the delivery of EBRT-CT. The pattern of acute and late toxicity differed. Standard treated patients had more chronic proctitis while the surgically treated had acute complications of surgery and hydronephrosis. At a maximum follow-up of 60 months, median follow-up 26 (2-31) and 22 (3-27) months for the surgery and standard therapy respectively, eight patients per group have recurred and died. The progression free and overall survival are the same in both groups.
The results of this study suggest that radical hysterectomy can be used after EBRT-CT without compromising survival in FIGO stage IB2-IIB cervical cancer patients in settings were brachytherapy is not available. A randomized study is needed to uncover the value of surgery after EBRT-CT.
目前宫颈癌放射治疗的范例是，腔内近距离放射治疗是根治性治疗的重要组成部分。这是一项配对回顾性比较，对比了接受外照射化疗放疗（EBRT-CT）加根治性子宫切除术的患者与接受相同化疗放疗后再进行近距离放射治疗的患者的治疗结果。
在这项非随机比较中，两组各40例患者的EBRT-CT方案相同。在标准治疗组患者中，完成外照射后2周内进行一到两次腔内铯（低剂量率）照射，以使A点剂量达到至少85 Gy。在手术治疗组患者中，在EBRT-CT后7周内进行根治性子宫切除术及双侧盆腔淋巴结清扫和腹主动脉旁淋巴结取样。评估反应、毒性和生存率。
共分析了80例患者。接受EBRT-CT和手术的患者与标准治疗病例进行了配对。两组之间的临床病理特征或EBRT-CT的实施情况均无差异。急性和晚期毒性模式不同。标准治疗组患者慢性直肠炎更多，而手术治疗组有手术急性并发症和肾积水。最大随访60个月，手术组和标准治疗组的中位随访时间分别为26（2-31）个月和22（3-27）个月，每组均有8例患者复发和死亡。两组的无进展生存期和总生存期相同。
本研究结果表明，在无法进行近距离放射治疗的情况下，对于FIGO IB2-IIB期宫颈癌患者，EBRT-CT后可进行根治性子宫切除术，且不影响生存率。需要进行一项随机研究以揭示EBRT-CT后手术的价值。
