光动力疗法联合锥切术对早期宫颈癌年轻患者生育功能的保留：一项前瞻性研究。
Fertility preservation by photodynamic therapy combined with conization in young patients with early stage cervical cancer: a pilot study.
作者信息
Choi Min Chul, Jung Sang Geun, Park Hyun, Lee Sun Young, Lee Chan, Hwang Yeun Young, Kim Seung Jo
机构信息
Comprehensive Gynecologic Cancer Center, Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, South Korea.
Comprehensive Gynecologic Cancer Center, Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, South Korea.
出版信息
Photodiagnosis Photodyn Ther. 2014 Sep;11(3):420-5. doi: 10.1016/j.pdpdt.2014.06.001. Epub 2014 Jun 10.
BACKGROUND
Vaginal radical trachelectomy (VRT) is the standard fertility preserving procedure for early stage cervical cancer patients. There have been reports in the literature, however, that VRT to be too radical procedure for early stage cervical cancer, as its post-operative obstetric morbidity was high. In this study, PDT with Loop electrosurgical excision procedure (LEEP) or conization was investigated as a less radical fertility preserving treatment alternative to VRT for early stage cervical cancer patients.
METHODS
We analyzed data of 21 patients with early stage cervical cancer (stages IA-IIA) who underwent PDT with LEEP/conization from 2003 to 2012. LEEP or conization was performed before PDT in every case. For patients in stage IB1 or above, only those who were confirmed to be free of malignancy in frozen section by pelvic lymph node dissection received PDT. Surface photoillumination with red laser light at a wavelength of 630nm was applied to the cervix and the endocervical canal 48h after intravenous injection of 2mg/kg of photosensitizer.
RESULTS
Median age of the 21 patients was 31 years old (range: 22-43), 19 patients (90.5%) of whom were nulliparous. Majority of the lesions were at stage IA1 (47.6%) or IB1 (42.9%). Histologically, 80.9% were squamous cell carcinoma. 5 patients (23.8%) had a lesion of 2cm or larger in diameter. There was one recurrence (4.7%) and no death during 52.6 months (6-114 months). Of the 13 women who attempted to get pregnant, 10 (76.9%) women conceived a total of 11 pregnancies. The first and second trimester miscarriages were 2 and 1 respectively, and 7 (70%) of the pregnancies reached the third trimester, of which 5 delivered at term. No tumor-related deaths or PDT-related severe adverse effects were noted.
CONCLUSION
PDT combined with LEEP/conization could be an effective fertility sparing conservative treatment for young patients with early stage cervical cancer.
背景
阴道根治性宫颈切除术（VRT）是早期宫颈癌患者保留生育功能的标准手术。然而，文献中有报道称，VRT对早期宫颈癌而言手术过于激进，因为其术后产科发病率较高。在本研究中，探讨了光动力疗法（PDT）联合环形电切术（LEEP）或锥切术作为早期宫颈癌患者一种较保守的保留生育功能的治疗选择，替代VRT。
方法
我们分析了2003年至2012年期间接受PDT联合LEEP/锥切术的21例早期宫颈癌（IA-IIA期）患者的数据。每例患者在PDT前均进行了LEEP或锥切术。对于IB1期及以上的患者，只有那些经盆腔淋巴结清扫冰冻切片证实无恶性肿瘤的患者才接受PDT。在静脉注射2mg/kg光敏剂48小时后，用波长为630nm的红色激光对宫颈和宫颈管进行表面光照射。
结果
21例患者的中位年龄为31岁（范围：22-43岁），其中19例（90.5%）未生育。大多数病变处于IA1期（47.6%）或IB1期（42.9%）。组织学上，80.9%为鳞状细胞癌。5例（23.8%）患者的病变直径为2cm或更大。在52.6个月（6-114个月）期间有1例复发（4.7%），无死亡病例。在13名尝试怀孕的女性中，10名（76.9%）女性共怀孕11次。孕早期和孕中期流产分别为2次和1次，7次（70%）怀孕进入孕晚期，其中5次足月分娩。未观察到与肿瘤相关的死亡或与PDT相关的严重不良反应。
结论
PDT联合LEEP/锥切术可能是早期宫颈癌年轻患者一种有效的保留生育功能的保守治疗方法。
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