Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea.
Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
Cancer Res Treat. 2016 Jan;48(1):259-65. doi: 10.4143/crt.2014.370. Epub 2015 Mar 20.
Adjuvant chemoradiation following primary surgery is frequently indicated in patients with stage IB cervical cancer. The aim of this study is to evaluate the role of a magnetic resonance imaging (MRI)-based strategy in avoiding trimodality therapy.
We retrospectively reviewed all patients with stage IB cervical cancer treated initially with primary surgery at Seoul National University Hospital. We suggest an alternative triage strategy in which the primary treatment modality is determined based on preoperative MRI findings. Using this strategy, primary surgery is only indicated when there is no evidence of parametrial involvement (PMI) and lymph node metastasis (LNM) in the MRI results; when there is evidence of either or both of these factors, primary chemoradiation is selected. Assuming that this strategy is applied to our cohort, we evaluate how the rate of trimodality therapy is affected.
Of the 254 patients in our sample, 77 (30.3%) had at least one category 1 risk factor (PMI, LNM, positive resection margin) upon pathologic examination. If the MRI-based strategy had been applied to our cohort, 168 patients would have undergone primary surgery and 86 would have undergone primary chemoradiation. Only 25 patients (9.8%) would have required trimodality therapy based on an indication of at least one category 1 pathologic risk factor following radical hysterectomy.
The inclusion of MRI in the decision-making process for primary treatment modality could have reduced the number of patients requiring trimodality therapy based on the indication of a category 1 risk factor from 30.3% to 9.8% in our cohort.
在 IB 期宫颈癌患者中，通常需要在初次手术后进行辅助放化疗。本研究旨在评估基于磁共振成像（MRI）的策略在避免三联疗法中的作用。
我们回顾性分析了在首尔国立大学医院接受初次手术治疗的所有 IB 期宫颈癌患者。我们提出了一种替代的分类策略，即根据术前 MRI 结果确定主要治疗方式。使用该策略，仅当 MRI 结果中没有宫旁浸润（PMI）和淋巴结转移（LNM）证据时才选择行单纯手术治疗；当存在这些因素中的任何一个或两个因素的证据时，则选择行放化疗。假设该策略适用于我们的队列，我们评估三联疗法的比例如何受到影响。
在我们的样本中，有 254 例患者，其中 77 例（30.3%）在病理检查时至少有一个 1 类风险因素（PMI、LNM、阳性切缘）。如果根据 MRI 制定策略，168 例患者将接受单纯手术治疗，86 例患者将接受单纯放化疗。只有 25 例患者（9.8%）在根治性子宫切除术后根据至少一个 1 类病理风险因素的指征需要三联疗法。
将 MRI 纳入主要治疗方式的决策过程中，可使我们的队列中需要三联疗法的患者数量从 30.3%减少到 9.8%，其指征为 1 类风险因素。
