Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
Int J Gynecol Cancer. 2013 Jun;23(5):923-8. doi: 10.1097/IGC.0b013e318290ea8f.
It is well documented that recurrence after pelvic exenteration remains high (up to 50%), and patients may require a prolonged period of recuperation following this aggressive surgery. We conducted a retrospective review to evaluate the feasibility of administering adjuvant chemotherapy after pelvic exenteration for gynecologic malignancies.
We reviewed the medical records of patients with any gynecologic cancer who underwent exenterative surgery between January 2005 and February 2011 at our institution. Patients were referred for postexenteration adjuvant chemotherapy based on surgeon's discretion and/or presence of high-risk features: positive margins, positive lymph nodes, and/or lymphovascular space invasion. Suitability for chemotherapy was assessed by a gynecologic medical oncologist. Regimens consisted of 4 to 6 cycles of platinum-based doublet chemotherapy. Chemotherapy-related toxicities were assessed using the Common Terminology Criteria for Adverse Events version 4.
We identified 42 patients who underwent pelvic exenteration during the study period. Eleven (26%) were referred for adjuvant chemotherapy. Three (27%) of the 11 patients did not receive chemotherapy because of delayed postoperative recovery or physician choice. Seven (88%) of the remaining 8 patients completed all scheduled chemotherapy. Grade 2 toxicities or greater were documented in 6 patients (75%), the most common being neutropenia, neuropathy, and fatigue. Median follow-up time was 25 months (range, 6-56 months). The 3-year progression-free and overall survival rates of the 8 patients who received chemotherapy were 58% (95% confidence interval, 18%-84%) and 54% (95% confidence interval, 13%- 83%), respectively.
The administration of adjuvant chemotherapy is feasible for a select group of patients after pelvic exenteration for gynecologic malignancies. Our results need to be interpreted with caution because of the small and heterogeneous cohort of patients included.
大量文献记录显示，盆腔廓清术后复发率仍然很高（高达 50%），患者在接受这种侵袭性手术后可能需要长时间恢复。我们进行了一项回顾性研究，以评估妇科恶性肿瘤盆腔廓清术后辅助化疗的可行性。
我们回顾了 2005 年 1 月至 2011 年 2 月期间在我院接受廓清手术的任何妇科癌症患者的病历。根据外科医生的判断和/或存在高危特征（切缘阳性、淋巴结阳性和/或淋巴管血管间隙浸润），将患者转诊接受廓清术后辅助化疗。化疗的适宜性由妇科肿瘤内科医生进行评估。方案包括 4 至 6 个周期的铂类双联化疗。使用不良事件通用术语标准 4 版评估化疗相关毒性。
我们确定了 42 名在研究期间接受盆腔廓清术的患者。11 名（26%）患者被转诊接受辅助化疗。由于术后恢复延迟或医生选择，11 名患者中有 3 名（27%）未接受化疗。8 名患者中的 7 名（88%）完成了所有计划的化疗。有 6 名患者（75%）出现 2 级及以上毒性，最常见的是中性粒细胞减少症、周围神经病和疲劳。中位随访时间为 25 个月（范围 6-56 个月）。接受化疗的 8 名患者的 3 年无进展生存率和总生存率分别为 58%（95%置信区间 18%-84%）和 54%（95%置信区间 13%-83%）。
对于接受妇科恶性肿瘤盆腔廓清术的少数患者，辅助化疗是可行的。由于纳入的患者数量小且异质性大，我们的结果需要谨慎解释。
