Department of Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
Gynecol Oncol. 2013 Oct;131(1):99-102. doi: 10.1016/j.ygyno.2013.07.085. Epub 2013 Jul 19.
This study aimed to evaluate the efficacy of radiation therapy for pelvic lymph node metastasis from uterine cervical cancer and identify an optimal radiation regimen.
A total of 111 metastatic pelvic lymph nodes, ranging from 11 to 56 mm (median, 25 mm) on CT/MRI, in 62 patients with uterine cervical cancer were treated initially with curative radiation therapy, with 46 patients receiving concurrent chemotherapy. Total radiation doses ranged from 45 to 61.2 Gy (median, 50.4 Gy) in 1.8-2 Gy (median, 1.8 Gy) fractions.
At a median follow-up of 33 months, 46 of the 62 patients survived. Only 2 irradiated lymph nodes, 24 and 28 mm in diameter, in 1 patient progressed after irradiation alone with 50.4 Gy in 1.8 Gy fractions. All 33 metastatic lymph nodes ≥ 30 mm in diameter were controlled by irradiation at a median dose of 55.8 Gy. The 3-year lymph node-progression free rates were 98.2% in all 62 patients and 98.0% in all 111 metastatic lymph nodes. Except for transient hematologic reactions, 2 patients developed grade ≥ 3 therapy-related toxicities, 1 with an ulcer and the other with perforation of the sigmoid colon. In addition, 2 patients experienced ileus after irradiation.
Radiation therapy effectively controlled pelvic lymph node metastases in patients with uterine cervical cancer, with most nodes <24 mm in diameter controlled by total doses of 50.4 Gy in 1.8 Gy fractions and larger nodes controlled by 55.8 Gy, particularly with concurrent chemotherapy. Higher doses to metastatic lymph nodes may increase intestinal toxicities.
本研究旨在评估宫颈癌盆腔淋巴结转移的放疗疗效，并确定最佳放疗方案。
对 62 例宫颈癌患者的 111 个转移性盆腔淋巴结（CT/MRI 上范围为 11-56mm，中位数为 25mm）进行初始根治性放疗，其中 46 例接受同步化疗。总放疗剂量范围为 45-61.2Gy（中位数为 50.4Gy），分割剂量为 1.8-2Gy（中位数为 1.8Gy）。
中位随访 33 个月时，62 例患者中有 46 例存活。仅 1 例患者在接受 50.4Gy 1.8Gy 分割剂量放疗后，2 个直径分别为 24mm 和 28mm 的照射淋巴结单独进展。所有直径≥30mm 的 33 个转移性淋巴结均通过中位剂量为 55.8Gy 的放疗得到控制。62 例患者的 3 年淋巴结无进展率为 98.2%，111 个转移性淋巴结的 3 年淋巴结无进展率为 98.0%。除短暂的血液学反应外，2 例患者发生≥3 级治疗相关毒性反应，1 例为溃疡，另 1 例为乙状结肠穿孔。此外，2 例患者在放疗后发生肠梗阻。
放疗能有效控制宫颈癌患者的盆腔淋巴结转移，大多数直径<24mm 的淋巴结可通过总剂量为 50.4Gy 的 1.8Gy 分割剂量控制，较大的淋巴结可通过 55.8Gy 控制，尤其是同步化疗。对转移性淋巴结给予更高的剂量可能会增加肠道毒性。
