Bignardi M, Bardelli D, Bertoni F, Tordiglione M
Divisione di Radioterapia, Ospedale Multizonale, Varese.
Radiol Med. 1988 May;75(5):540-4.
The best way to treat locally recurrent carcinoma of the uterine cervix has not been established. Our retrospective study refers to 37 consecutive patients, with recurrence in the pelvis, treated by radiotherapy alone. Thirty patients were treated by external beam therapy alone; intracavitary brachytherapy alone was adopted in 3 patients and a combination of both techniques in 4 patients. The total radiation dose exceeded 60 Gy in 62% of cases. A complete clinical response was observed in 54% of patients and a partial response in 32.4%. Overall crude survival was 70.3%, 28.9% and 23.2% at 1, 3 and 5 years respectively. In patients with recurrent tumors less than 40 mm in diameter a threefold 3-year survival was achieved (48.6% vs. 14.5%, p less than 0.025). With total doses higher than 60 Gy the 3-year survival resulted to be far better than with lower doses (39.1% vs. 10%, p less than 0.025). A significant advantage was also observed in the "complete responders" group (44% vs. 11.8%), but this difference can be explained by the link between response and the above-mentioned basic prognostic factors. Acute side effects and late complications were moderate and did not correlate with the type of primary treatment. A significant percentage (about 25%) of patients with locally recurrent cervix carcinoma may reach medium-term survival; better results can be achieved in selected groups with favourable prognostic factors and with adequate radiotherapeutic treatment.
子宫颈局部复发癌的最佳治疗方法尚未确定。我们的回顾性研究涉及37例连续的盆腔复发患者，仅接受放射治疗。30例患者仅接受外照射治疗；3例患者仅采用腔内近距离放疗，4例患者采用两种技术联合治疗。62%的病例总辐射剂量超过60 Gy。54%的患者观察到完全临床缓解，32.4%的患者观察到部分缓解。1年、3年和5年的总体粗生存率分别为70.3%、28.9%和23.2%。在直径小于40 mm的复发肿瘤患者中，3年生存率提高了两倍（48.6%对14.5%，p<0.025）。总剂量高于60 Gy时，3年生存率远高于较低剂量（39.1%对10%，p<0.025）。在“完全缓解者”组中也观察到显著优势（44%对11.8%），但这种差异可以通过缓解与上述基本预后因素之间的联系来解释。急性副作用和晚期并发症为中度，与初始治疗类型无关。相当比例（约25%）的子宫颈局部复发癌患者可能达到中期生存；在具有有利预后因素且接受充分放射治疗的选定组中可以取得更好的结果。
