Perez C A, Kao M S
Int J Radiat Oncol Biol Phys. 1985 Nov;11(11):1903-9. doi: 10.1016/0360-3016(85)90270-6.
This retrospective analysis reports the results of therapy in 128 patients with carcinoma of the uterine cervix classified as barrel-shaped or expanded cervix (over 5 cm in diameter). Seventy-five percent of the patients were treated with irradiation alone and 25% with combinations of irradiation and surgery. The results of therapy are compared with those observed in 714 patients with non-barrel-shaped carcinoma of the uterine cervix treated with similar techniques during the same period of time. The distribution of histological type of tumor was similar in both groups (90% epidermoid carcinoma, 8% adenocarcinoma, and 2% adenosquamous carcinoma). Approximately 15% of the patients in both groups with Stage IB and 25% with Stage IIA and IIB had positive endometrial curettings (stromal invasion or replacement by tumor only). Thus, the aggressive behavior observed in the barrel-shaped tumors is not a result of endometrial involvement, but to the large volume of tumor present. The actuarial 5-year tumor free survival in Stage IB barrel-shaped cervix was 76% compared to 92% in the non-barrel-shaped lesions. In Stage IIA the 5-year NED survival for patients with barrel-shaped cervix was 60 compared to 80% for the patients with non-barrel-shaped cervix. In Stage IIB the survival rates were 58 and 70%, respectively. A noteworthy finding in this analysis is the high incidence of distant metastases in the patients with barrel-shaped cervix (32% in Stage IB, 40% in Stage IIA, and 32% in Stage IIB) in comparison with patients with non-barrel-shaped tumors (10% in Stage IB, 16% in Stage IIA, and 25% in Stage IIB). The incidence of pelvic failures was comparable in both groups. Higher doses of irradiation resulted in better tumor control, which was comparable to that observed with a combination of irradiation and surgery (conservative hysterectomy). The 5-year survival rate in Stage IB was similar in both the barrel-shaped and non-barrel-shaped tumors treated with irradiation alone or combination irradiation and surgery. In Stage IIA the non-barrel-shaped lesions had the same survival with either treatment technique. In the barrel-shape group, eight patients treated with irradiation alone or survival of 70%, compared to 45% in 24 patients treated with irradiation alone. However, these differences are not statistically significant (p = .50). In eight patients treated with definitive irradiation and a lymphadenectomy and four patients irradiated after an exploratory laparotomy, two major and three minor (grade 2) complications were noted.(ABSTRACT TRUNCATED AT 400 WORDS)
这项回顾性分析报告了128例子宫颈癌患者的治疗结果，这些患者的子宫颈癌被分类为桶状或扩张型子宫颈（直径超过5厘米）。75%的患者仅接受放疗，25%的患者接受放疗与手术联合治疗。将治疗结果与同期采用类似技术治疗的714例非桶状子宫颈癌患者的观察结果进行比较。两组肿瘤的组织学类型分布相似（90%为表皮样癌，8%为腺癌，2%为腺鳞癌）。两组中约15%的IB期患者和25%的IIA期及IIB期患者刮宫内膜检查呈阳性（仅间质浸润或被肿瘤取代）。因此，桶状肿瘤中观察到的侵袭性行为并非子宫内膜受累所致，而是由于肿瘤体积较大。IB期桶状子宫颈癌患者的5年无瘤生存率为76%，而非桶状病变患者为92%。IIA期桶状子宫颈癌患者的5年无疾病生存（NED）率为60%，而非桶状子宫颈癌患者为80%。IIB期的生存率分别为58%和70%。该分析中一个值得注意的发现是，与非桶状肿瘤患者相比，桶状子宫颈癌患者远处转移的发生率较高（IB期为32%，IIA期为40%，IIB期为32%，而非桶状肿瘤患者在IB期为10%，IIA期为16%，IIB期为25%）。两组盆腔失败的发生率相当。更高剂量的放疗导致更好的肿瘤控制，这与放疗与手术联合治疗（保守性子宫切除术）的效果相当。单独放疗或放疗与手术联合治疗的IB期桶状和非桶状肿瘤患者的5年生存率相似。IIA期非桶状病变采用任何一种治疗技术的生存率相同。在桶状组中，8例仅接受放疗的患者生存率为70%，而24例仅接受放疗的患者生存率为45%。然而，这些差异无统计学意义（p = 0.50）。在8例接受根治性放疗和淋巴结清扫术的患者以及4例在剖腹探查术后接受放疗的患者中，记录到2例严重并发症和3例轻微（2级）并发症。（摘要截断于400字）
