Department of Radiooncology, Charité Universitätsmedizin Berlin, Berlin, Germany. simone.marnitz @ charite.de
Oncology. 2012;83(6):346-53. doi: 10.1159/000341659. Epub 2012 Sep 18.
To determine the rate of unavoidable adjuvant chemoradiation (RCTX) due to histologic results after radical surgery in patients with early cervical cancer.
Between May 2004 and July 2011, 448 consecutive patients diagnosed with invasive cervical cancer stage IA1 L1 to IIA underwent laparoscopic staging at the Department of Gynecology and Gynecologic Oncology at Charité Berlin. Only in patients without lymph node metastases (n = 394) on frozen section, radical operation was continued either by laparoscopic radical hysterectomy (n = 228) or by radical vaginal trachelectomy (n = 166). The decision for adjuvant RCTX was reached among the members of an interdisciplinary tumor board according to the presence of risk factors. The mean age of patients was 39 years. Squamous cell cancer was found in 62.5%, adenocarcinoma in 32.7%, adenosquamous cancer in 3.8% and others in 1% of patients. Adjuvant treatment was indicated if at least one category 1 risk factor (pN1, R1 or RX, parametrial involvement) and/or any combination of category 2 risk factors (lymphovascular space involvement (LVSI), hemovascular space involvement, grading 3, young age, deep stromal invasion, large tumor size) were present.
In 39 of 394 patients (9.9%), adjuvant RCTX was recommended due to category 1 risk factors (n = 25/6.4%) and category 2 risk factors (n = 14/3.5%). Tumor-involved (R0) or unclear resection margins (RX) were present in 4 (1%) and 1 (0.3%), parametrial involvement in 12 (3%) and positive lymph nodes in 11 (2.8%) patients, respectively. Hemovascular involvement was found in 14 (3.5%), LVSI in 113 (28.7%) and grading 3 in 122 (31%) patients, respectively.
Laparoscopic staging is a reliable tool to keep the rate of tri-modal (surgery + chemotherapy + radiotherapy) treatments in patients with cervical cancer stage I and IIA after radical surgery at 10%. This percentage should be used as benchmark for the quality of interdisciplinary treatment of patients diagnosed with cervical cancer.
确定在接受根治性手术后，早期宫颈癌患者因组织学结果而不得不接受辅助放化疗（RCTX）的比例。
2004 年 5 月至 2011 年 7 月，448 例浸润性宫颈癌 IA1 L1 至 IIA 期患者在柏林 Charité 妇产科接受了腹腔镜分期。仅在冷冻切片上无淋巴结转移（n=394）的患者中，继续进行根治性手术，包括腹腔镜根治性子宫切除术（n=228）或根治性阴道子宫切除术（n=166）。根据风险因素，跨学科肿瘤委员会的成员决定是否进行辅助 RCTX。患者的平均年龄为 39 岁。62.5%的患者为鳞状细胞癌，32.7%为腺癌，3.8%为腺鳞癌，1%为其他类型。如果至少存在 1 个 1 类风险因素（pN1、R1 或 RX、宫旁累及）和/或任何 2 类风险因素（脉管间隙浸润（LVSI）、血管间隙浸润、分级 3、年轻、深肌层浸润、肿瘤较大）的组合，则需要进行辅助治疗。
在 394 例患者中（9.9%），由于 1 类风险因素（n=25/6.4%）和 2 类风险因素（n=14/3.5%），推荐了辅助 RCTX。肿瘤累及（R0）或切缘不明确（RX）分别存在于 4（1%）和 1（0.3%）例患者中，宫旁累及分别存在于 12（3%）和 11（2.8%）例患者中，阳性淋巴结分别存在于 11（2.8%）和 11（2.8%）例患者中。血管浸润分别存在于 14（3.5%）、113（28.7%）和 122（31%）例患者中，LVSI 分别存在于 11（2.8%）、113（28.7%）和 122（31%）例患者中，分级 3 分别存在于 12（3%）、113（28.7%）和 122（31%）例患者中。
腹腔镜分期是一种可靠的工具，可将 IA1 和 IIA 期宫颈癌患者根治性手术后接受三联（手术+化疗+放疗）治疗的比例保持在 10%。该百分比可作为诊断为宫颈癌患者接受跨学科治疗质量的基准。
