De Vincenzo Rosa, Amadio Giulia, Ricci Caterina, Licameli Angelo, Ferrandina Gabriella, Capelli Giovanni, Scambia Giovanni
Gynaecologic Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy.
Vaccine. 2009 May 29;27 Suppl 1:A39-45. doi: 10.1016/j.vaccine.2008.11.110.
Treatment of cervical cancer greatly varies according to the stage of the disease. Laparoscopic surgical staging is emerging as a valid approach, compared to clinical and imaging staging, to better identify the treatment plan. Minimally invasive surgery plays the greatest role in the treatment of early cervical carcinoma (ECC). Laparoscopically assisted radical vaginal hysterectomy (LARVH) is an alternative surgical strategy in this subset of patients. Interest has been increasing in using conservative fertility-sparing surgery such as laparoscopic vaginal radical trachelectomy (LVRT) or chemo-conization, options to be preferred in selected patients, with early-stage disease and asking for future fertility. Chemoradiotherapy currently represents the gold standard in the treatment of patient with locally advanced cervical cancer (LACC). In Italy, neoadjuvant chemotherapy (NACT) followed by radical surgery is today emerging as a valid alternative to the standard chemoradiation and the paclitaxel, ifosfamide and cisplatin (TIP) regimen is one of the most active neoadjuvant chemotherapeutic treatments. Moreover, the combination of different strategies to maximize local control should be considered. Among different approaches to this issue the use of a three-modality treatment, including radiotherapy, chemotherapy and surgery has been investigated. Our data on a large single-institutional series of LACC patients treated with chemoradiation followed by radical surgery confirm that this three-modality treatment can achieve overall survival (OS) and Disease Free Survival (DFS) rates at least comparable to chemoradiation alone, with an acceptable rate of complications. Tailoring of radical surgery, on the basis of intraoperative findings, such as lympho-nodes status, might play an important role in diminishing the overall rate of complications and eventually improve quality of life (QoL) of these patients. Cervical cancer generally has an aggressive impact on relatively young women and, as we experienced, the relevance of psychosocial aspects in gynaecologic oncology has become a main issue.
宫颈癌的治疗会因疾病分期的不同而有很大差异。与临床分期和影像学分期相比，腹腔镜手术分期正成为一种有效的方法，能更好地确定治疗方案。微创手术在早期宫颈癌（ECC）的治疗中发挥着最大作用。腹腔镜辅助根治性阴道子宫切除术（LARVH）是这类患者的一种替代手术策略。对于有生育需求且处于疾病早期的特定患者，使用保留生育功能的保守手术，如腹腔镜阴道根治性宫颈切除术（LVRT）或化疗锥切术，受到的关注日益增加。目前，放化疗是局部晚期宫颈癌（LACC）患者治疗的金标准。在意大利，新辅助化疗（NACT）后行根治性手术正成为标准放化疗的一种有效替代方案，而紫杉醇、异环磷酰胺和顺铂（TIP）方案是最有效的新辅助化疗方案之一。此外，应考虑采用不同策略的组合以最大化局部控制。在针对这个问题的不同方法中，已经对包括放疗、化疗和手术在内的三联疗法进行了研究。我们对大量接受放化疗后行根治性手术的LACC患者的单机构系列研究数据证实，这种三联疗法能够实现的总生存率（OS）和无病生存率（DFS）至少与单纯放化疗相当，且并发症发生率可接受。根据术中发现（如淋巴结状态）调整根治性手术，可能在降低总体并发症发生率并最终改善这些患者的生活质量（QoL）方面发挥重要作用。宫颈癌通常对相对年轻的女性有侵袭性影响，正如我们所经历的，心理社会因素在妇科肿瘤学中的相关性已成为一个主要问题。
