Höckel M, Knapstein P G, Kutzner J
Department of Obstetrics and Gynecology, University of Mainz, Germany.
Surg Gynecol Obstet. 1991 Oct;173(4):297-302.
Patients who have recurrent gynecologic malignant conditions infiltrating the pelvic wall still have a poor prognosis, although based on the biologic factor of the tumor, 50 per cent might be salvaged if local control is achieved. For patients with unilateral disease, we have designed a combined operative and radiotherapeutic treatment (CORT) that involves subtotal resection of the tumor, intraoperative placement of guiding tubes for postoperative high dose rate brachytherapy of the residual tumor and tumor bed at the pelvic wall and pelvic wall plasty with autologous tissue flaps. We use either flaps of the greater omentum and inferiorly based rectus abdominis muscle flaps from the abdominal route or (de-epithelialized) gluteal thigh flaps from the vaginal and perineal route to cover the tumor bed and overlying tubes. Thus, a protective distance between the radiation source and radiointolerant pelvic organs is created and the risk of local infection and hypoxia is reduced. With this combination of surgical and radiation treatment, the therapeutic ratio between tumor control and tissue damage in the pelvic area is thought to be improved. Higher local doses can be applied compared with conventional methods in instances in which surgical treatment has been performed and reirradiation with tumoricidal doses may be possible after primary or adjuvant radiation therapy. The encouraging first experience with the CORT concept in nine patients with a short follow-up period is reported.
患有复发性妇科恶性疾病且肿瘤浸润盆腔壁的患者预后仍然很差，尽管根据肿瘤的生物学因素，如果实现局部控制，50%的患者可能会得到挽救。对于单侧疾病患者，我们设计了一种手术与放疗联合治疗（CORT）方法，包括肿瘤次全切除、术中放置引导管以便术后对残留肿瘤和盆腔壁肿瘤床进行高剂量率近距离放疗，以及用自体组织瓣进行盆腔壁整形。我们采用腹部途径的大网膜瓣和下腹直肌瓣，或经阴道和会阴途径的（去上皮化）臀股瓣来覆盖肿瘤床及上方的导管。这样，在放射源与不耐受辐射的盆腔器官之间形成了一个保护距离，降低了局部感染和缺氧的风险。通过这种手术与放疗相结合的方法，人们认为盆腔区域肿瘤控制与组织损伤之间的治疗比得到了改善。与传统方法相比，在已经进行手术治疗的情况下，可以给予更高的局部剂量，并且在初次或辅助放疗后，有可能再次给予杀肿瘤剂量的放疗。本文报告了对9例患者采用CORT概念的初步令人鼓舞的经验，随访期较短。
