Kucera H, Vavra N
I. Universitäts-Frauenklinik, Wien.
Wien Klin Wochenschr. 1990 Aug 3;102(15):432-7.
The value of adjuvant irradiation in stage Ib cervical cancer is not clear. In a retrospective study of 171 cases of stage Ib cervical cancer tumor grading, tumor size, blood and lymphatic vessel invasion and pelvic lymph node metastases were analysed. A simple score of these risk factors is proposed enabling assignment into patient groups of similar risk on the basis of a points system for individual prognostic factors. 90 patients were treated by radical surgery alone, 81 patients received adjuvant pelvic irradiation (56 Gy). 5-year survival after surgery alone was 95.6%, in comparison with only 79% after adjuvant irradiation (p less than 0.001). However, when patients with a similar risk score are compared, the outcome of adjuvant irradiation was found to be favourable. With a score of 6 to 10 points 5-year survival after surgery alone was 75%, whilst with adjuvant irradiation the rate rose to 92%. In this risk group relapses were observed after surgery alone in 37%, whilst with adjuvant irradiation only 4% relapsed. 20 of 21 deceased patients had a risk score of 6 and more points. The incidence of risk factors in the group treated by surgery alone was significantly lower than in the group with adjuvant irradiation (p less than 0.0001). Therefore the unfavourable result in the group given adjuvant irradiation becomes quite clear. Adjuvant irradiation is recommended in stage Ib cervical cancer for patients with a risk score of 6 and more points. Adjuvant radiotherapy should not be hastily replaced by other modalities of adjuvant treatment.
I期宫颈癌辅助放疗的价值尚不清楚。在一项对171例I期宫颈癌的回顾性研究中，分析了肿瘤分级、肿瘤大小、血管和淋巴管侵犯以及盆腔淋巴结转移情况。提出了这些危险因素的简单评分，以便根据个体预后因素的评分系统将患者分为风险相似的组。90例患者仅接受根治性手术治疗，81例患者接受辅助盆腔放疗（56 Gy）。单纯手术后的5年生存率为95.6%，而辅助放疗后的5年生存率仅为79%（p<0.001）。然而，当比较风险评分相似的患者时，发现辅助放疗的结果是有利的。风险评分为6至10分的患者，单纯手术后的5年生存率为75%，而辅助放疗后这一比例升至92%。在这个风险组中，单纯手术后观察到37%的复发率，而辅助放疗后仅4%复发。21例死亡患者中有20例的风险评分为6分及以上。单纯手术治疗组的危险因素发生率明显低于辅助放疗组（p<0.0001）。因此，辅助放疗组的不良结果就很明显了。对于风险评分为6分及以上的I期宫颈癌患者，建议进行辅助放疗。辅助放疗不应被其他辅助治疗方式仓促取代。
