局部晚期宫颈癌的管理：新趋势与争议问题
Management for locally advanced cervical cancer: new trends and controversial issues.
作者信息
Cho Oyeon, Chun Mison
机构信息
Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea.
出版信息
Radiat Oncol J. 2018 Dec;36(4):254-264. doi: 10.3857/roj.2018.00500. Epub 2018 Dec 31.
Abstract
This article reviewed new trends and controversial issues, including the intensification of chemotherapy and recent brachytherapy (BT) advances, and also reviewed recent consensuses from different societies on the management of locally advanced cervical cancer (LACC). Intensive chemotherapy during and after radiation therapy (RT) was not recommended as a standard treatment due to severe toxicities reported by several studies. The use of positron emission tomography-computed tomography (PET-CT) and magnetic resonance imaging (MRI) for pelvic RT planning has increased the clinical utilization of intensity-modulated radiation therapy (IMRT) for the evaluation of pelvic lymph node metastasis and pelvic bone marrow. Recent RT techniques for LACC patients mainly aim to minimize toxicities by sparing the normal bladder and rectum tissues and shortening the overall treatment time by administering a simultaneous integrated boost for metastatic pelvic lymph node in pelvic IMRT followed by MRI-based image guided adaptive BT.
摘要
本文回顾了新趋势和有争议的问题，包括化疗的强化及近期近距离放疗（BT）的进展，还回顾了不同学会关于局部晚期宫颈癌（LACC）管理的近期共识。由于多项研究报告的严重毒性，放疗（RT）期间及之后的强化化疗不被推荐作为标准治疗。正电子发射断层扫描 - 计算机断层扫描（PET-CT）和磁共振成像（MRI）在盆腔RT计划中的应用增加了调强放射治疗（IMRT）在评估盆腔淋巴结转移和盆腔骨髓方面的临床应用。LACC患者的近期RT技术主要旨在通过 sparing正常膀胱和直肠组织来最小化毒性，并通过在盆腔IMRT中对转移性盆腔淋巴结进行同步整合加量，随后进行基于MRI的图像引导适应性BT来缩短总治疗时间。 （注：原文中“sparing”可能有误，推测应为“sparing”，意为“ sparing正常膀胱和直肠组织来最小化毒性” ）
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本文引用的文献
1
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J Transl Med. 2018 Nov 26;16(1):326. doi: 10.1186/s12967-018-1703-4.
2
Workflow and efficiency in MRI-based high-dose-rate brachytherapy for cervical cancer in a high-volume brachytherapy center.高容量近距离放射治疗中心基于MRI的宫颈癌高剂量率近距离放射治疗的工作流程与效率
Brachytherapy. 2018 Sep-Oct;17(5):753-760. doi: 10.1016/j.brachy.2018.05.001. Epub 2018 May 26.
3
The European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology Guidelines for the Management of Patients With Cervical Cancer.《欧洲妇科肿瘤学会/欧洲放射肿瘤学会/欧洲病理学会宫颈癌管理指南》。
Int J Gynecol Cancer. 2018 May;28(4):641-655. doi: 10.1097/IGC.0000000000001216.
4
The EMBRACE II study: The outcome and prospect of two decades of evolution within the GEC-ESTRO GYN working group and the EMBRACE studies.EMBRACE II研究：GEC-ESTRO妇科工作组及EMBRACE研究二十年发展的成果与展望
Clin Transl Radiat Oncol. 2018 Jan 11;9:48-60. doi: 10.1016/j.ctro.2018.01.001. eCollection 2018 Feb.
5
Anemia, leukocytosis and thrombocytosis as prognostic factors in patients with cervical cancer treated with radical chemoradiotherapy: A retrospective cohort study.贫血、白细胞增多和血小板增多作为接受根治性放化疗的宫颈癌患者的预后因素：一项回顾性队列研究。
Clin Transl Radiat Oncol. 2017 Jun 12;4:51-56. doi: 10.1016/j.ctro.2017.05.001. eCollection 2017 Jun.
6
Neoadjuvant Chemotherapy Followed by Radical Surgery Versus Concomitant Chemotherapy and Radiotherapy in Patients With Stage IB2, IIA, or IIB Squamous Cervical Cancer: A Randomized Controlled Trial.新辅助化疗后行根治性手术与同期放化疗治疗 IB2 期、IIA 期或 IIB 期鳞癌宫颈癌患者的随机对照研究。
J Clin Oncol. 2018 Jun 1;36(16):1548-1555. doi: 10.1200/JCO.2017.75.9985. Epub 2018 Feb 12.
7
Prognostic value of HPV DNA status in cervical cancer before treatment: a systematic review and meta-analysis.治疗前宫颈癌中HPV DNA状态的预后价值：一项系统评价和荟萃分析。
Oncotarget. 2017 Jun 16;8(39):66352-66359. doi: 10.18632/oncotarget.18558. eCollection 2017 Sep 12.
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9
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10
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