Zobec Logar Helena Barbara
Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia.
Radiol Oncol. 2017 Jun 16;51(4):447-454. doi: 10.1515/raon-2017-0024. eCollection 2017 Dec.
The aim of this retrospective single institution study was to analyse long term results of vulvar cancer treatment with conventional 2D radiotherapy in Slovenia between years 1997-2004.
Fifty-six patients, median age 74.4 years +/- 9.7 years, mainly stage T2 or T3, were included in the study. All patients were treated with radiotherapy, which was combined with surgery (group A), used as the primary treatment (group B) or at the time of relapse (group C). Chemotherapy was added in some patients. Histology, grade, lymph node status, details of surgery, radiation dose to the primary tumour, inguinofemoral and pelvic area as well as local control (LC) and survival were evaluated.
Overall survival (OS), disease specific survival (DSS) and LC rates at 10-years for all patients were as follows: 22.7%, 34.5% and 41.1%, respectively. The best 10-years results of the treatment were achieved in the primary operated patients treated with adjuvant radiotherapy +/-chemotherapy (OS 31.9%, DSS 40.6% and LC 47.6%). Positive lymph nodes had a strong influence on LC. In case of positive nodes LC decreased by 60% (p = 0.03) and survival decreased by 50% (p = 0.2). There was a trend to a better LC with higher doses ≥ 54.0 Gy (p = 0.05).
The best treatment option for patients with advanced vulvar cancer is combined treatment with surgery and radiotherapy +/- chemotherapy, if feasible. Radiotherapy with the dose of ≥ 54.0 Gy should be considered to achieve better LC if positive adverse factors are present.
这项回顾性单机构研究的目的是分析1997年至2004年间斯洛文尼亚采用传统二维放射疗法治疗外阴癌的长期结果。
本研究纳入了56例患者，中位年龄74.4岁±9.7岁，主要为T2或T3期。所有患者均接受放射治疗，放疗联合手术（A组）、作为主要治疗手段（B组）或在复发时使用（C组）。部分患者加用了化疗。评估了组织学、分级、淋巴结状态、手术细节、原发肿瘤、腹股沟股区和盆腔区域的放射剂量以及局部控制（LC）和生存率。
所有患者10年的总生存率（OS）、疾病特异性生存率（DSS）和局部控制率如下：分别为22.7%、34.5%和41.1%。接受辅助放疗±化疗的初次手术患者治疗的10年最佳结果为：OS 31.9%、DSS 40.6%和LC 47.6%。阳性淋巴结对局部控制有很大影响。淋巴结阳性时，局部控制率下降60%（p = 0.03），生存率下降50%（p = 0.2）。剂量≥54.0 Gy时有局部控制更好的趋势（p = 0.05）。
对于晚期外阴癌患者，如果可行，最佳治疗选择是手术联合放疗±化疗。如果存在阳性不良因素，应考虑采用≥54.0 Gy的放疗剂量以实现更好的局部控制。
