Radiology Department, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, Prague, Czechia.
Second Faculty of Medicine, Charles University, Prague, Czechia.
Pathol Oncol Res. 2021 Sep 28;27:1609915. doi: 10.3389/pore.2021.1609915. eCollection 2021.
Surgical treatment is preferred therapy of early-stage cervical carcinoma. In the risk of cancer recurrence surgery is often followed by adjuvant radiotherapy. In our retrospective study we aimed at identifying late (≥6 months) and very late (≥5 years) radiation adverse effects on imaging scans as CT, PET/CT and MRI in patients who underwent successful treatment for cervical carcinoma by radical surgery combined with radiotherapy ± chemotherapy. We correlated imaging results with clinical manifestations. We selected young and middle-aged patients with long life expectancy, as late radiation-related toxicities may significantly affect their quality of life. Patients were selected from those who were primary diagnosed and treated between the years 1987-2011 and regularly visited our Oncology department in years 2011-2012. Following inclusion criteria were applied: age ≤55 years at diagnosis, clinical follow-up ≥5 years and at least one tomography scan ≥3 years after finished treatment. One hundred and three subjects were reviewed: 73 patients met all inclusion criteria, while 30 patients fulfilled the inclusion criteria except for available tomography scan ≥3 years after therapy. The mean imaging follow-up was 11.2 ± 7.6 years and the mean clinical follow-up was 15.0 ± 6.9 years. In 20 (27%) subjects 27 cases grade I radiation-related toxicities were found; 9 (33%) of those 27 cases were clinically silent. In 14 (19%) females only grade I toxicities were observed. Grade III-IV toxicities were found in 5 (6.8%) subjects. No grade V toxicities were observed. We concluded that severe late side effects caused by radiotherapy were exceedingly rare in females successfully treated for early-stage cervical carcinoma, only 1 bilateral osteonecrosis, 2 cases of ileus, and 2 potentially radiation-induced tumors were found. The majority of radiation-related comorbidities found on imaging scans were clinically silent.
手术治疗是早期宫颈癌的首选治疗方法。为了降低癌症复发的风险，手术后常需要辅助放疗。在我们的回顾性研究中，我们旨在确定成功接受根治性手术联合放化疗治疗宫颈癌的患者在 CT、PET/CT 和 MRI 等影像学检查上出现≥6 个月（晚期）和≥5 年（极晚期）的放射不良反应，并将影像学结果与临床表现相关联。我们选择了年轻和中年、预期寿命长的患者，因为晚期放射相关毒性可能会显著影响他们的生活质量。这些患者是从 1987 年至 2011 年期间首次诊断和治疗的患者中筛选出来的，并在 2011 年至 2012 年期间定期到我院肿瘤科就诊。纳入标准如下：诊断时年龄≤55 岁，临床随访≥5 年，且治疗结束后至少有一次 CT 扫描≥3 年。共回顾了 103 例患者：73 例患者均符合所有纳入标准，30 例患者除了缺乏治疗结束后≥3 年的 CT 扫描外，其余均符合纳入标准。影像学随访平均时间为 11.2±7.6 年，临床随访平均时间为 15.0±6.9 年。在 20 例（27%）患者中发现了 27 例Ⅰ级放射性相关毒性，其中 9 例（33%）为无症状性。14 例（19%）女性患者仅观察到Ⅰ级毒性。在 5 例（6.8%）患者中发现了Ⅲ-Ⅳ级毒性。未观察到Ⅴ级毒性。我们的结论是，在成功治疗早期宫颈癌的女性中，放射治疗引起的严重晚期副作用非常罕见，仅发现 1 例双侧骨坏死、2 例肠梗阻和 2 例可能由辐射引起的肿瘤。在影像学检查上发现的大多数放射相关并发症在临床上是无症状的。
