Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Gynecol Oncol. 2018 Mar;148(3):474-479. doi: 10.1016/j.ygyno.2018.01.007. Epub 2018 Jan 12.
To evaluate the effectiveness and long-term side effects of definitive groin radiotherapy for vulvar cancer with grossly involved inguinal lymph nodes.
The records of 407 women with vulvar squamous cell carcinoma treated with radiotherapy at one institution during 1992-2014 were reviewed to identify patients who had radiographic or histologic evidence of grossly involved inguinal lymph nodes. Patients with lymphadenectomy before radiotherapy and patients treated for recurrent disease were excluded. Actuarial incidences of vulvar, inguinal, and distant recurrences, the relationship between vulvar recurrence and inguinal recurrence, and overall survival were analyzed using the Kaplan-Meier method.
Thirty-three patients were identified. The median age at diagnosis was 64 years. The median long-axis radiographic diameter of the largest inguinal lymph node or lymph node mass was 2.5 cm (range, 1.4-8.7). Sixteen patients (48%) also had evidence of pelvic lymph node metastasis. The median radiation dose delivered to grossly involved nodes was 66.0 Gy (range, 60.0-70.0). The 3-year actuarial incidences of vulvar, groin, and distant recurrences were 24.2%, 17.7%, and 30.3%, respectively. With a median follow-up time of 28 months (range, 2-196), four patients (12%) had groin recurrence, of whom three also had vulvar recurrence. There were few major late adverse effects of regional radiotherapy. The 3-year overall survival rate was 51%.
High-dose volume-directed radiotherapy achieves a high rate of local control with low risk of serious long-term toxic effects in patients with vulvar squamous cell carcinoma and grossly involved inguinal lymph nodes.
评估根治性腹股沟放疗对大体受累腹股沟淋巴结的外阴癌的有效性和长期副作用。
回顾了 1992 年至 2014 年期间一家机构治疗的 407 例外阴鳞状细胞癌患者的记录，以确定有影像学或组织学证据表明存在大体受累的腹股沟淋巴结的患者。排除了在放疗前进行淋巴结切除术和治疗复发性疾病的患者。使用 Kaplan-Meier 方法分析外阴、腹股沟和远处复发的发生率、外阴复发与腹股沟复发的关系以及总生存率。
确定了 33 例患者。诊断时的中位年龄为 64 岁。最大腹股沟淋巴结或淋巴结肿块的长轴放射直径中位数为 2.5cm（范围，1.4-8.7）。16 例患者（48%）也有盆腔淋巴结转移的证据。大体受累淋巴结接受的中位放射剂量为 66.0Gy（范围，60.0-70.0）。外阴、腹股沟和远处复发的 3 年累积发生率分别为 24.2%、17.7%和 30.3%。中位随访时间为 28 个月（范围，2-196），4 例患者（12%）出现腹股沟复发，其中 3 例患者也出现外阴复发。区域放疗的严重晚期不良反应很少。3 年总生存率为 51%。
对于大体受累腹股沟淋巴结的外阴鳞状细胞癌患者，高剂量容积定向放疗可实现高局部控制率，且严重长期毒性作用的风险较低。
