Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, USA.
Int J Gynecol Cancer. 2013 Mar;23(3):553-8. doi: 10.1097/IGC.0b013e3182849d53.
The objective of this study was to compare morbidity and outcome following radical surgery with or without adjuvant radiation therapy (RT) in the treatment of stages IB1-IB2 cervical carcinoma.
We retrospectively identified 222 patients with stages IB1-IB2 cervical carcinoma treated initially with radical hysterectomy or radical trachelectomy with or without adjuvant RT from February 2000 to November 2009. All grade 3 or higher complications-those requiring interventional radiology, endoscopic evaluation, or operative intervention-were documented.
One hundred fifty-eight patients (71%) underwent radical hysterectomy; 64 (29%) underwent radical trachelectomy. One hundred fifty-three patients (69%) underwent surgery alone; 69 (31%) received adjuvant radiation with or without chemosensitization. There was a statistically significant difference in the rate of total grades 1 to 5 late complications between the surgery-alone and surgery + RT groups (12% vs 32%, respectively; P < 0.001); however, the rate of grade 3 or higher complications was similar (5% vs 4%, respectively; P = 0.999). The progression-free and overall survival rates of the entire cohort were both 95%. The 5-year progression-free survival rates for the surgery-alone and surgery + RT groups were 93% and 90% (P = 0.172). The overall survival rates were 96% and 91%, respectively (P = 0.332).
The majority of women with stages IB1-IB2 cervical cancer undergoing radical surgery do not require adjuvant RT, have excellent oncologic outcome, and have low severe complication rates. Nearly one third of our patients required postoperative radiation, with no statistically significant increase in severe complication rate and with similar oncologic outcomes compared with the surgery-only cohort. These data support the continued practice of radical surgery with individualized postoperative radiation for these patients.
本研究旨在比较根治性手术加或不加辅助放疗（RT）治疗 IB1-IB2 期宫颈癌的发病率和结局。
我们回顾性地确定了 2000 年 2 月至 2009 年 11 月期间，最初接受根治性子宫切除术或根治性子宫颈切除术加或不加辅助 RT 治疗的 222 例 IB1-IB2 期宫颈癌患者。所有 3 级或以上的并发症——需要介入放射学、内镜评估或手术干预的并发症——均被记录。
158 例（71%）患者行根治性子宫切除术；64 例（29%）患者行根治性子宫颈切除术。153 例（69%）患者行单纯手术治疗；69 例（31%）患者接受辅助放疗，加或不加化疗增敏。单纯手术组和手术加 RT 组的总 1-5 级晚期并发症发生率有显著统计学差异（分别为 12%和 32%，P<0.001）；然而，3 级或以上并发症的发生率相似（分别为 5%和 4%，P=0.999）。整个队列的无进展生存率和总生存率均为 95%。单纯手术组和手术加 RT 组的 5 年无进展生存率分别为 93%和 90%（P=0.172）。总生存率分别为 96%和 91%（P=0.332）。
大多数接受根治性手术治疗的 IB1-IB2 期宫颈癌患者不需要辅助 RT，具有良好的肿瘤学结局，且严重并发症发生率较低。近三分之一的患者需要术后放疗，但严重并发症发生率没有统计学意义增加，与单纯手术组的肿瘤学结局相似。这些数据支持继续对这些患者行根治性手术，个体化地进行术后放疗。
