Espenel S, Garcia M-A, Vallard A, Langrand-Escure J, Guy J-B, Trone J-C, Ben Mrad M, Chauleur C, de Laroche G, Moreno-Acosta P, Rancoule C, Magné N
Department of radiotherapy, institut de cancérologie de la Loire-Lucien-Neuwirth, 108, bis avenue Albert-Raimond, BP60008, 42270 Saint-Priest-en-Jarez cedex, France.
Public health department, institut de cancérologie de la Loire-Lucien-Neuwirth, 108, bis avenue Albert-Raimond, BP60008, 42270 Saint-Priest-en-Jarez cedex, France.
Cancer Radiother. 2018 Dec;22(8):790-796. doi: 10.1016/j.canrad.2018.03.006. Epub 2018 Oct 19.
The aim of the present study was to identify management strategies and outcomes of patients with stage IB1 cervical cancer with high recurrence risk.
Medical files of all consecutive patients treated between 2004 and 2017 with external beam radiotherapy and/or brachytherapy for IB1 cervical cancer, whatever the lymph node status, were retrospectively reviewed.
Forty-two patients were included, with a median age of 49.8 years old. Median tumour size, estimated with the initial pelvic magnetic resonance imaging, was 26mm (interquartile range [IQR]=19.5-35). Histological types were mainly squamous cell carcinoma (59.5%) and adenocarcinoma (33.3%). Lymphovascular invasion was reported for 38.1% of patients. Pelvic lymph nodes were involved for eight patients (19.0%). Surgery was performed for 39 patients (92.9%). A neoadjuvant treatment was delivered for 20 patients (47.6%), an adjuvant treatment for 19 patients (45.2%) and an exclusive radiotherapy (with or without chemotherapy) followed by brachytherapy for three patients (7.1%). Pathologic complete response was achieved in 61.5% of patients. With a median follow-up of 5.8 years (IQR=2.6-9.4), five patients (11.9%) experienced a tumour relapse. The five-year disease-free survival was 79.5% (95% confident interval [CI]=66.9-94.4), the five-year overall survival was 87.8% (95% CI=77.2-99.8), and the five-year disease-specific survival was 94.2% (95% CI=86.7-100).
In current clinical practice, tailored treatments are delivered, and seems to give correct therapeutic index. However, clinical trials are needed to standardise treatment according to patient characteristics and recurrence risk factors.
本研究旨在确定具有高复发风险的IB1期宫颈癌患者的管理策略及治疗结果。
回顾性分析2004年至2017年间接受外照射放疗和/或近距离放疗治疗的所有连续性IB1期宫颈癌患者的病历，无论其淋巴结状态如何。
纳入42例患者，中位年龄49.8岁。根据初始盆腔磁共振成像估计，肿瘤中位大小为26mm（四分位间距[IQR]=19.5 - 35）。组织学类型主要为鳞状细胞癌（59.5%）和腺癌（33.3%）。38.1%的患者有淋巴血管浸润。8例患者（19.0%）盆腔淋巴结受累。39例患者（92.9%）接受了手术。20例患者（47.6%）接受了新辅助治疗，19例患者（45.2%）接受了辅助治疗，3例患者（7.1%）接受了单纯放疗（联合或不联合化疗）后行近距离放疗。61.5%的患者达到病理完全缓解。中位随访5.8年（IQR=2.6 - 9.4），5例患者（11.9%）出现肿瘤复发。5年无病生存率为79.5%（95%置信区间[CI]=66.9 - 94.4），5年总生存率为87.8%（95% CI=77.2 - 99.8），5年疾病特异性生存率为94.2%（95% CI=86.7 - 100）。
在当前临床实践中，采用了个体化治疗，且似乎能给出正确的治疗指数。然而，需要进行临床试验以根据患者特征和复发风险因素来规范治疗。
