Escande Alexandre, Gouy Sebastien, Mazeron Renaud, Bentivegna Enrica, Bacorro Warren, Maroun Pierre, Schernberg Antoine, Oberlander Anne-Sophie, Dumas Isabelle, Genestie Catherine, Deutsch Eric, Morice Philippe, Haie-Meder Christine, Chargari Cyrus
Department of Radiotherapy, Brachytherapy Unit, Gustave Roussy Cancer Campus, France.
Department of Surgery, Gustave Roussy Cancer Campus, France.
Gynecol Oncol. 2017 Mar;144(3):541-546. doi: 10.1016/j.ygyno.2016.12.026. Epub 2017 Jan 15.
To report clinical results of a multimodal strategy based on preoperative brachytherapy followed with surgery in early stage cervical cancer.
MATERIALS/METHODS: The outcome of consecutive patients receiving brachytherapy in our Institution for an early stage IB1-IIA1 invasive cervical cancer with risk factors (lymphovascular embols and/or tumor >2cm) between 2000 and 2013 was analyzed. The treatment consisted of preoperative low dose or pulse dose-rate utero-vaginal brachytherapy followed, 6-8weeks later, by a radical hysterectomy/bilateral salpingo-oophorectomy plus pelvic±para-aortic lymph node dissection. A postoperative chemoradiation was delivered in patients with histological evidence of lymph nodes metastases.
182 patients were identified. Histological examination of hysterectomy specimen showed the presence of a tumor residuum in 55 patients (30.2%). One patient (0.5%) had residual tumor cells in the parametria. With a median follow-up of 5.3years, 14 patients (7.7%) presented tumor relapse, including three (1.6%) local relapses. Five-year disease-free survival (DFS) rate was 93.6% (95%CI: 91.6-95.6%). In log-rank analysis, presence of pelvic nodal metastases at time of lymphadenectomy (p=0.001) and tumor size ≥3cm (p=0.003) correlated with a poorer DFS. Presence of a tumor residuum on hysterectomy specimen correlated with a higher risk of pelvic or para-aortic failure (p=0.035). A time interval>10weeks between brachytherapy and surgery correlated with a higher risk of failure outside the pelvis (p=0.003). Significant postoperative complications were reported in 16 patients (8.8%). All delayed toxicities were mild to moderate.
A preoperative brachytherapy is a safe and effective option in early stage cervical cancer.
报告基于术前近距离放射治疗后行手术治疗的早期宫颈癌多模式治疗策略的临床结果。
材料/方法：分析2000年至2013年间在我院接受近距离放射治疗的连续早期IB1-IIA1期伴有危险因素（淋巴管浸润和/或肿瘤>2cm）的浸润性宫颈癌患者的治疗结果。治疗包括术前低剂量或脉冲剂量率子宫阴道近距离放射治疗，6-8周后行根治性子宫切除术/双侧输卵管卵巢切除术加盆腔±腹主动脉旁淋巴结清扫术。有淋巴结转移组织学证据的患者接受术后放化疗。
共纳入182例患者。子宫切除标本的组织学检查显示55例患者（30.2%）存在肿瘤残留。1例患者（0.5%）在宫旁组织中有残留肿瘤细胞。中位随访5.3年，14例患者（7.7%）出现肿瘤复发，其中3例（1.6%）为局部复发。5年无病生存率（DFS）为93.6%（95%CI：91.6-95.6%）。对数秩分析显示，淋巴结清扫时盆腔淋巴结转移（p=0.001）和肿瘤大小≥3cm（p=0.003）与较差的DFS相关。子宫切除标本中存在肿瘤残留与盆腔或腹主动脉旁复发风险较高相关（p=0.035）。近距离放射治疗与手术之间的时间间隔>10周与盆腔外复发风险较高相关（p=0.003）。16例患者（8.8%）报告有严重术后并发症。所有迟发性毒性均为轻至中度。
术前近距离放射治疗是早期宫颈癌的一种安全有效的治疗选择。
