Annede P, Gouy S, Haie-Meder C, Morice P, Chargari C
Département de radiothérapie, Gustave-Roussy Cancer Campus, Villejuif, 94800, France; Ecole du Val-de-Grâce, Paris 75005, France; Département de Radiothérapie, Institut Paoli-Calmettes, Marseille, 13009, France.
Département de chirurgie, Gustave Roussy Cancer Campus, Villejuif, 94800, France.
Cancer Radiother. 2019 Oct;23(6-7):737-744. doi: 10.1016/j.canrad.2019.07.151. Epub 2019 Aug 24.
The treatment of cervical cancer patients relies on surgery and radiotherapy (according to the stage) and requires a multimodal discussion before any treatment to avoid adding the morbidities of each individual intervention and to optimize functional and oncological outcomes. The places of surgery and radiotherapy have been highlighted in recent international guidelines. For early stage tumors, an exclusive surgery with or without fertility sparing (according to well defined criteria) is the therapeutic standard. For tumors with risk factors (measuring more than 2cm in size and/or presence of lymphovascular invasion) a preoperative brachytherapy can be proposed to minimize the need for postoperative external beam radiotherapy and optimize local control. For locally advanced disease, the standard treatment relies on chemoradiation followed by a brachytherapy boost. A primary paraaortic lymph node dissection may guide radiotherapy volumes and is useful to identify patients requiring a para-aortic radiotherapy. The technical evolutions of surgical approaches and technological improvement of radiotherapy and brachytherapy should be analyzed in the context of prospective studies. We review the literature on the respective places of radiotherapy and surgery for the treatment of cervical cancer.
宫颈癌患者的治疗依赖于手术和放疗（根据分期），并且在任何治疗前都需要进行多模式讨论，以避免增加每种单独干预的发病率，并优化功能和肿瘤学结局。手术和放疗的地位在最近的国际指南中得到了强调。对于早期肿瘤，根据明确标准，采用保留或不保留生育功能的单纯手术是治疗标准。对于有危险因素的肿瘤（尺寸超过2cm和/或存在脉管浸润），可建议术前近距离放疗，以尽量减少术后外照射放疗的需求并优化局部控制。对于局部晚期疾病，标准治疗依赖于同步放化疗，随后进行近距离放疗强化。原发性腹主动脉旁淋巴结清扫术可指导放疗范围，有助于识别需要进行腹主动脉旁放疗的患者。手术方法的技术进展以及放疗和近距离放疗的技术改进应在前瞻性研究的背景下进行分析。我们回顾了关于放疗和手术在宫颈癌治疗中各自地位的文献。
