de la Rochefordiere Anne, Kirova Youlia, Alran Severine, Plancher Corine, Fourchotte Virginie, Beuzeboc Philippe, de Margerie Vincent, Petrow Peter, Sastre-Garau Xavier, Servois Vincent, Scholl Suzy, Cottu Paul, Mignot Laurent, de Cremoux Patricia, Salmon Remy
Radiation Oncology, for Gynaecology Study Group of the Institut Curie, Paris, France.
Clin Med Oncol. 2008;2:227-36. doi: 10.4137/cmo.s489. Epub 2008 Mar 27.
To evaluate the treatment results of patients (pts) with FIGO stage IB2, IIA, IIB cervical carcinoma (CC) treated with pre-operative radio-chemotherapy, followed by extended radical hysterectomy.
Retrospective study of 148 women treated to the Institut Curie for operable FIGO Stage IB2 to IIB, biopsy proved CC. Among them, 70 pts, median age 46 years, were treated using the same regimen associating primary radio-cisplatinum based chemotherapy, intracavitary LDR brachytherapy, followed by extended radical hysterectomy. Kaplan-Meier estimates were used to draw survival curves. Comparisons of survival distribution were assessed by the log-rank test.
Complete histological local-regional response was obtained in 56% of the pts (n = 39). Residual macroscopic or microscopic disease in the cervix was observed in 28 pts (40%). All but one had in-situ microscopic residual CC. Lateral residual disease in the parametria was also present in 9 pts, all with residual CC. Pelvic lymph nodes were free from microscopic disease in 56 pts (80%). Eight of 55 (11%) radiological N0 patients had microscopic nodal involvement, as compared to 6/15 (40%) radiological N1 (p = 0.03). Seventeen pts (25%) had residual cervix disease but negative nodes. After median follow-up of 40 months (range, 8-141), 38/70 patients (54.1%) are still alive and free of disease, 6 (8.6%) alive with disease, and 11 (15.8%) patients were lost for follow-up but free of disease.
The treatment of locally advanced CC needs a new multidisciplinary diagnostic and treatment approach using new therapeutic arms to improve the survival and treatment tolerance among women presenting this disease.
评估国际妇产科联盟（FIGO）分期为IB2、IIA、IIB期的宫颈癌（CC）患者术前接受放化疗，随后行广泛性子宫切除术的治疗效果。
对148例因FIGO IB2至IIB期可手术治疗、活检证实为CC而在居里研究所接受治疗的女性进行回顾性研究。其中70例患者，中位年龄46岁，采用相同方案治疗，包括以顺铂为主的原发性化疗、腔内近距离低剂量率放疗，随后行广泛性子宫切除术。采用Kaplan-Meier法估计绘制生存曲线。生存分布的比较采用对数秩检验进行评估。
56%（n = 39）的患者获得了完全组织学局部区域缓解。28例（40%）患者宫颈存在残留肉眼可见或显微镜下可见的疾病。除1例患者外，其余均有原位显微镜下残留CC。9例患者的宫旁组织也存在外侧残留疾病，均伴有残留CC。56例（80%）患者盆腔淋巴结无显微镜下可见疾病。55例影像学检查为N0的患者中有8例（11%）存在显微镜下淋巴结受累，而15例影像学检查为N1的患者中有6例（40%）受累（p = 0.03）。17例（25%）患者宫颈有残留疾病但淋巴结阴性。中位随访40个月（范围8 - 141个月）后，70例患者中有38例（54.1%）仍存活且无疾病，6例（8.6%）带瘤存活，11例（15.8%）患者失访但无疾病。
局部晚期CC的治疗需要一种新的多学科诊断和治疗方法，采用新的治疗手段，以提高患该疾病女性的生存率和治疗耐受性。
