Perez C A, Kuske R R, Camel H M, Galakatos A E, Hederman M A, Kao M S, Walz B J
Radiation Oncology Center, Mallinckrodt Institute of Radiology, St. Louis, MO 63110.
Int J Radiat Oncol Biol Phys. 1988 Apr;14(4):613-21. doi: 10.1016/0360-3016(88)90081-8.
A total of 1054 patients with histologically confirmed invasive carcinoma of the uterine cervix were treated with radiation therapy alone between 1959 and 1982. All patients are available for a minimum of 3 years follow-up. Radiation therapy consisted of external irradiation to the whole pelvis (1000-2000 cGy) and parametria (for a total of 4000-6000 cGy) combined with two intracavitary radioactive source insertions (6000-7500 cGy to point A). Patients with Stage IIB, III, and IVA have been consistently treated with somewhat higher doses of external irradiation and intracavitary insertions. A small group of 54 patients with Stage IIB or IIIB had pelvic lymphadenectomy following the irradiation (1960-1964). There was a strong correlation between the tumor regression within 30 days from completion of radiotherapy and the incidence of pelvic recurrences or distant metastases for each of the anatomical stages. The 10-year survival rate for Stage IB was 76%, Stage IIA 60%, Stage IIB 45%, and Stage III 25%. Many of the deaths were due to intercurrent disease. Thus, the 10-year tumor-free survival was 80% for Stage IB, 60% for Stages IIA and IIB and 35% for Stage III. In Stage IB total doses of 6000 cGy or higher to point A resulted in 94% pelvic tumor control. In Stage IIA, the pelvic tumor control was 87% with doses of 6000 cGy to point A or higher. However, in Stage IIB the pelvic tumor control was 58% with doses below 6000 cGy, 78% with 6001-7500 cGy and 82% with higher doses. In Stage IIIB the pelvic tumor control was 42% with doses below 6000 cGy, 57% with 6001-7500 cGy and 68% with higher doses. Tumor control in the pelvis was correlated with the following 5 year survivals: Stage IB-95% (353 patients); Stage IIA-84% (116 patients); Stage IIB-84% (308 patients); Stage IIIB-74% (245 patients). The 5-year survival for patients that recurred in the pelvis was 30% for Stage IB, about 15% for Stages IIA-B and only 5% in Stage III. Patients with tumor control in the pelvis had a significantly lower incidence of distant metastases than patients who initially failed in the pelvis (9.3% vs. 58.6% in Stage IB, 21.6% vs 52.6% in Stage IIA, 19.8% vs 16.7% in Stage IIB, and 31.2% vs 50% in Stage III). In Stage IIB the figures were 19.8% and 16.7% because the initial pelvic recurrence was frequently concurrent with distant metastases.(ABSTRACT TRUNCATED AT 400 WORDS)
1959年至1982年间，共有1054例经组织学确诊的子宫颈浸润癌患者仅接受了放射治疗。所有患者均至少有3年的随访资料。放射治疗包括对整个盆腔进行外照射（1000 - 2000 cGy）和对宫旁组织照射（总量4000 - 6000 cGy），并结合两次腔内放射源植入（A点剂量为6000 - 7500 cGy）。IIB期、III期和IVA期患者一直接受剂量稍高的外照射和腔内植入治疗。一小部分54例IIB期或IIIB期患者在放疗后（1960 - 1964年）进行了盆腔淋巴结清扫术。放疗结束后30天内肿瘤的消退情况与各解剖分期的盆腔复发或远处转移发生率之间存在密切相关性。IB期的10年生存率为76%，IIA期为60%，IIB期为45%，III期为25%。许多死亡是由并发疾病导致的。因此，IB期的10年无瘤生存率为80%，IIA期和IIB期为60%，III期为35%。在IB期，A点总剂量达到6000 cGy或更高时，盆腔肿瘤控制率为94%。在IIA期，A点剂量为6000 cGy或更高时，盆腔肿瘤控制率为87%。然而，在IIB期，剂量低于6000 cGy时盆腔肿瘤控制率为58%，6001 - 7500 cGy时为78%，更高剂量时为82%。在IIIB期，剂量低于6000 cGy时盆腔肿瘤控制率为42%，6001 - 7500 cGy时为57%，更高剂量时为68%。盆腔肿瘤控制情况与以下5年生存率相关：IB期 - 95%（353例患者）；IIA期 - 84%（116例患者）；IIB期 - 84%（308例患者）；IIIB期 - 74%（245例患者）。盆腔复发患者的5年生存率在IB期为30%，IIA - B期约为15%，III期仅为5%。盆腔肿瘤得到控制的患者远处转移发生率明显低于最初盆腔治疗失败的患者（IB期：9.3%对58.6%；IIA期：21.6%对(52.6%)；IIB期：19.8%对16.7%；III期：31.2%对50%）。在IIB期，上述数字为19.8%和16.7%，因为最初的盆腔复发常与远处转移同时发生。（摘要截取自400字）
