Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands.
Cancer Treat Rev. 2022 Jan;102:102311. doi: 10.1016/j.ctrv.2021.102311. Epub 2021 Nov 2.
Upon discovery of lymph node metastasis during radical hysterectomy with pelvic lymphadenectomy in early-stage cervical cancer, the gynaecologist may pursue one of two treatment strategies: abandonment of surgery followed by primary (chemo)radiotherapy (PRT) or completion of radical hysterectomy, followed by adjuvant (chemo)radiotherapy (RHRT). Current guidelines recommend PRT over RHRT, as combined treatment is presumably associated with increased morbidity. However, this review of literature suggests there are no significant differences in survival and recurrence and total proportions of adverse events between treatment strategies. Additionally, both strategies are associated with varying types of adverse events, and affect quality of life and sexual functioning differently, both in the short and long term. Although total proportions of adverse events were comparable between treatment strategies, lower extremity lymphoedema was reported more often after RHRT and symptom experience (e.g. distress from bladder or bowel problems) and sexual dysfunction more often after PRT. As reporting of adverse events, quality of life and sexual functioning were not standardised across the articles included, and covariate adjustment was not conducted in most of the analyses, comparability of studies is hampered. Accumulating retrospective evidence suggests no major differences on oncological outcome and morbidity after PRT and RHRT for intraoperatively discovered lymph node metastasis in cervical cancer. However, conclusions should be considered cautiously, as all studies were of retrospective design with small sample sizes. Still, treatment strategies seem to affect adverse events, quality of life and sexual functioning in different ways, allowing room for shared decision-making and personalised treatment.
在早期宫颈癌根治性子宫切除术和盆腔淋巴结清扫术中发现淋巴结转移后，妇科医生可能会选择以下两种治疗策略之一：放弃手术，行原发（放）化疗（PRT）；或完成根治性子宫切除术，然后行辅助（放）化疗（RHRT）。目前的指南推荐 PRT 优于 RHRT，因为联合治疗可能会增加发病率。然而，这篇文献综述表明，两种治疗策略在生存和复发以及不良事件的总比例方面没有显著差异。此外，两种策略都与不同类型的不良事件相关，并且对生活质量和性功能的短期和长期影响也不同。尽管两种治疗策略的不良事件总比例相当，但 RHRT 后下肢淋巴水肿的报告更为常见，而 PRT 后膀胱或肠道问题引起的不适和性功能障碍更为常见。由于纳入的文章中对不良事件、生活质量和性功能的报告没有标准化，并且大多数分析中没有进行协变量调整，因此研究之间的可比性受到阻碍。越来越多的回顾性证据表明，对于术中发现的宫颈癌淋巴结转移，PRT 和 RHRT 在肿瘤学结果和发病率方面没有显著差异。然而，由于所有研究均为回顾性设计且样本量较小，因此应谨慎得出结论。尽管如此，治疗策略似乎以不同的方式影响不良事件、生活质量和性功能，为共同决策和个性化治疗提供了空间。
