Li Fengshuang, Wu Yumei, Kong Weimin, Wang Jiandong, Hao Xia, Niu Juwei, Bai Laifu
Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100006, China.
J Cancer Res Ther. 2017;13(5):796-800. doi: 10.4103/jcrt.JCRT_398_17.
The purpose of this study was to evaluate the clinical efficacy of preoperative vaginal intracavitary irradiation for Stage Ib2 and IIa cervical cancer.
From June 2008 to June 2014, data from 78 Stage Ib2 and IIa cervical cancer patients (age ≤75 years) with a diameter of local lesions >4 cm were collected in our hospital. Before treatment, all cases were confirmed by biopsy. The patients' general state was good, Karnofsky Performance Score ≥90, heart and lung functioning was normal, and patients were able to tolerate the surgery. The 78 patients were randomly divided into two groups: neoadjuvant radiotherapy group (NRG) (n = 38) and radical surgery group (n = 40). Patients in NRG received 2000~3000 cGy192 Ir irradiation of preoperatively intracavitary brachytherapy (radioactive source at 1 cm distance). After a rest of 10-14 days, radical hysterectomy with pelvic lymphadenectomy was performed. Surgery alone group (SAG) (n = 40) underwent radical surgery directly. The treatment outcomes between these two groups were compared, and the effect of preoperative intracavitary brachytherapy and presence of postoperative complications were evaluated.
The total clinical efficacy for intracavitary brachytherapy was 94.7% (36/38) with complete response 13 (34.2%), partial response 23 (60.5%), and stable disease 2 (5.3%). Moreover, no patients developed progression disease; for SAG patients, 32 cases successfully finished the extensive hysterectomy and pelvic lymphadenectomy. Operation time <240 min was found in 19 patients. Moreover, the positive complication for lymphatic cyst and urinary retention was 20.0% and 15.0%, respectively. For NAG group, 36 patients successfully finished the extensive hysterectomy and pelvic lymphadenectomy. Operation time <240 min was found in 22 patients. Moreover, the positive complication for lymphatic cyst and urinary retention was 15.8% and 13.2%, respectively. The median follow-up time for NRG and SAG was 28 and 30 months, respectively. Three cases lost to follow-up in the SAG with the follow-up rate of 92.5% (37/40). In the NRG group, 3 cases lost to follow-up with the follow-up rate of 92.1% (35/38). The locoregional control rate for 1, 3, and 5 years was 80.0%, 61.3%, and 52.6%, respectively, for SAG group and 89.5%, 82.9%, and 76.9%, respectively, for NRG group with significant statistical difference for 3 and 5 years.
Preoperative intracavitary brachytherapy is an effective procedure for the treatment for Stage Ib2 and IIa cervical cancer and can significantly improve the locoregional control rate.
本研究旨在评估术前阴道腔内照射治疗Ib2期和IIa期宫颈癌的临床疗效。
收集我院2008年6月至2014年6月收治的78例Ib2期和IIa期宫颈癌患者（年龄≤75岁），局部病灶直径>4 cm。治疗前，所有病例均经活检确诊。患者一般状况良好，卡氏评分≥90分，心肺功能正常，能够耐受手术。78例患者随机分为两组：新辅助放疗组（NRG）（n = 38）和根治性手术组（n = 40）。NRG组患者接受术前腔内近距离放疗20003000 cGy 192Ir照射（放射源距离1 cm）。休息1014天后，行根治性子宫切除术及盆腔淋巴结清扫术。单纯手术组（SAG）（n = 40）直接行根治性手术。比较两组治疗效果，评估术前腔内近距离放疗的效果及术后并发症情况。
腔内近距离放疗的总临床有效率为94.7%（36/38），完全缓解13例（34.2%），部分缓解23例（60.5%），病情稳定2例（5.3%）。此外，无患者病情进展；SAG组患者中，32例成功完成广泛子宫切除术及盆腔淋巴结清扫术。19例患者手术时间<240分钟。此外，淋巴囊肿和尿潴留的阳性并发症发生率分别为20.0%和15.0%。NRG组中，36例成功完成广泛子宫切除术及盆腔淋巴结清扫术。22例患者手术时间<240分钟。此外，淋巴囊肿和尿潴留的阳性并发症发生率分别为15.8%和13.2%。NRG组和SAG组的中位随访时间分别为28个月和30个月。SAG组3例失访，随访率为92.5%（37/40）。NRG组3例失访，随访率为92.1%（35/38）。SAG组1年、3年和5年的局部区域控制率分别为80.0%、61.3%和52.6%，NRG组分别为89.5%、82.9%和76.9%，3年和5年有显著统计学差异。
术前腔内近距离放疗是治疗Ib2期和IIa期宫颈癌的有效方法，可显著提高局部区域控制率。
