Besson N, Touboul E, Daraï É, Lefranc J-P, Monnier L, Schlienger M, Huguet F
Service d'oncologie radiothérapie, hôpital Tenon, hôpitaux universitaires Est parisien, 4, rue de la Chine, 75020 Paris, France.
Service d'oncologie radiothérapie, hôpital Tenon, hôpitaux universitaires Est parisien, 4, rue de la Chine, 75020 Paris, France; Faculté de médecine Pierre-et-Marie-Curie, université Paris VI, 4, rue de la Chine, 75020 Paris, France.
Cancer Radiother. 2014 Mar;18(2):83-8. doi: 10.1016/j.canrad.2013.11.010. Epub 2014 Jan 24.
Evaluation of the results of salvage radiation therapy with curative intent in the treatment of recurrent cervical carcinoma.
Fourteen patients with a recurrence of a cervical cancer were treated in our department between 1982 and 2009. Five patients had a pelvic relapse, four a vaginal relapse and five a pelvic lymph node relapse. Four patients had first a surgical resection of the relapse, which was incomplete in two patients. All patients had pelvic radiotherapy with a median dose of 55Gy in conventional fractionation. Concurrent chemotherapy was administered to 12 patients. A vaginal brachytherapy with a median dose of 20Gy was performed in addition in 3 patients. The median follow-up was 39months.
Safety of radiation therapy was correct with 29% of grade 3 acute or intestinal toxicity. Tumor control was observed in 10 patients (71%). Four patients presented a locoregional tumor progression. At the time of analysis, three patients had died from their cancer. From the date of relapse, the rate of overall survival at 2 and 5year was respectively 84% and 74%. Three patients (21%) had severe late effects.
In our experience, chemoradiotherapy can achieve a high rate of remission in patients with isolated pelvic recurrence of cervical cancer. This treatment is feasible only if the patient had not received radiation therapy before or if the relapse is out of the previously irradiated volume.
评估以治愈为目的的挽救性放射治疗复发性宫颈癌的效果。
1982年至2009年间，我科收治了14例复发性宫颈癌患者。5例为盆腔复发，4例为阴道复发，5例为盆腔淋巴结复发。4例患者首先接受了复发病灶的手术切除，其中2例切除不完全。所有患者均接受盆腔放疗，常规分割的中位剂量为55Gy。12例患者同时接受了化疗。另外3例患者还进行了中位剂量为20Gy的阴道近距离放疗。中位随访时间为39个月。
放射治疗安全性良好，3级急性或肠道毒性发生率为29%。10例患者（71%）实现了肿瘤控制。4例患者出现局部区域肿瘤进展。在分析时，3例患者死于癌症。自复发之日起，2年和5年的总生存率分别为84%和74%。3例患者（21%）出现严重晚期效应。
根据我们的经验，放化疗可使孤立性盆腔复发的宫颈癌患者获得较高的缓解率。仅当患者之前未接受过放射治疗或复发部位不在先前放疗范围内时，这种治疗才可行。
