Sharma Daya Nand, Rath Goura Kisor, Kumar Sunesh, Bhatla Neerja, Gandhi Ajeet Kumar, Sharma Piyush, Gupta Subhash, Julka Parmod Kumar
Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India.
Asian Pac J Cancer Prev. 2011;12(6):1537-41.
For cervical carcinoma, postoperative radiation therapy (PORT) following radical hysterectomy (RH) is indicated for certain adverse pathological factors. Simple hysterectomy (SH) is considered inadequate treatment for invasive cervical carcinoma and PORT is required for all such cases. Clinical outcome of patients receiving PORT following SH and RH may be different. The aim of our retrospective study is to compare the results of PORT following inadvertent SH or RH in cervical carcinoma.
During years 2003-2005, we treated 83 patients with cervical carcinoma with PORT following either SH (Group SH, 33 patients) or RH (Group RH, 50 patients). All patients were treated with pelvic external beam radiation therapy (EBRT) followed by intravaginal brachytherapy (IVBT). The endpoints of the study were local control, recurrence free survival (RFS) and delayed complications.
Median follow period up was 34 months (range 2-75 months). Local control rate observed in Gp SH and RH was 70% and 88% respectively with a p value of <0.05. Cumulative 5-year overall survival (OS) for combined group was 62%. Group RH patients had significantly better 5-year RFS than Group SH patients (72% and 49% respectively; p value 0.04). The frequency of Grade III-IV toxicity (bladder, rectum, and bowel) in Group SH versus Group RH was 6% vs 8% respectively (p value 0.1). The pedal lymph edema was higher in Group RH patients (10% vs 3%, p value<0.05).
PORT provides greater clinical benefit in patients who had undergone RH than SH for early stage invasive cervical carcinoma.
对于宫颈癌，根治性子宫切除术后进行术后放疗（PORT）适用于某些不良病理因素。单纯子宫切除术（SH）被认为对浸润性宫颈癌治疗不足，所有此类病例均需进行PORT。接受SH和RH后PORT治疗的患者的临床结果可能不同。我们这项回顾性研究的目的是比较宫颈癌患者意外接受SH或RH后PORT的结果。
在2003年至2005年期间，我们对83例宫颈癌患者进行了PORT治疗，其中接受SH的患者为一组（SH组，33例），接受RH的患者为另一组（RH组，50例）。所有患者均接受盆腔外照射放疗（EBRT），随后进行阴道内近距离放疗（IVBT）。研究的终点是局部控制、无复发生存期（RFS）和延迟并发症。
中位随访时间为34个月（范围2 - 75个月）。SH组和RH组的局部控制率分别为70%和88%，p值<0.05。联合组的累积5年总生存率（OS）为62%。RH组患者的5年RFS明显优于SH组患者（分别为72%和49%；p值0.04）。SH组与RH组III - IV级毒性（膀胱、直肠和肠道）的发生率分别为6%和8%（p值0.1）。RH组患者的足部淋巴水肿发生率更高（10%对3%，p值<0.05）。
对于早期浸润性宫颈癌患者，PORT在接受RH的患者中比接受SH的患者提供更大的临床益处。
