Brookland R K, Rubin S, Danoff B F
Int J Radiat Oncol Biol Phys. 1984 Oct;10(10):1875-9. doi: 10.1016/0360-3016(84)90265-7.
Between November 1974 and November 1979, 15 patients with cervical carcinoma were treated with extended field irradiation for biopsy proven para-aortic lymph node (PALN) metastases. Treatment consisted of pelvic and para-aortic irradiation at a daily dose of 180 to 200 rad per day, delivering 4000 to 6000 rad to the pelvis and 4000 to 5000 rad to the para-aortic nodes. One or two intracavitary insertions each delivered an additional 2000 to 3500 rad to point A. The three year actual disease free survival for the 12 patients with Stage I and II disease was 50%. All six survivors remain alive without evidence of disease for 41 to 93 months, with a mean and median follow-up of 65 months. All patients dying of disease did so within 26 months, all but one dying within one year. All patients with Stage III and IV are dead of disease. Pelvic disease was controlled in 11 of 12 patients with Stage I or II disease, and in one of the three patients with Stage III and IV disease. There was no clinical indication of failure in the PALN in any patient. Nine patients failed with disseminated disease. Three of 15 patients (20%) suffered serious treatment-related complications. Two of these were attributed to the pelvic irradiation, with one patient requiring a colostomy. Thus, complications resulting from the extended field irradiation were seen in only one patient (6.7%). There was no treatment related mortality. Extended field irradiation can lead to a 50% survival in patients with Stage I and II cervical carcinoma and PALN metastases, a survival comparable to that reported in patients with involved pelvic nodes.
1974年11月至1979年11月期间，对15例经活检证实有腹主动脉旁淋巴结（PALN）转移的宫颈癌患者进行了扩大野照射治疗。治疗包括盆腔和腹主动脉旁照射，每日剂量为180至200拉德，盆腔给予4000至6000拉德，腹主动脉旁淋巴结给予4000至5000拉德。每次腔内插入一或两次，在A点额外给予2000至3500拉德。12例I期和II期疾病患者的三年实际无病生存率为50%。所有6名幸存者均存活，无疾病证据，存活时间为41至93个月，平均随访时间和中位随访时间为65个月。所有死于疾病的患者均在26个月内死亡，除1例患者外，所有患者均在一年内死亡。所有III期和IV期患者均死于疾病。12例I期或II期疾病患者中有11例盆腔疾病得到控制，3例III期和IV期疾病患者中有1例盆腔疾病得到控制。任何患者的PALN均无临床失败迹象。9例患者因播散性疾病失败。15例患者中有3例（20%）出现严重的治疗相关并发症。其中2例归因于盆腔照射，1例患者需要进行结肠造口术。因此，仅1例患者（6.7%）出现了扩大野照射引起的并发症。无治疗相关死亡。扩大野照射可使I期和II期宫颈癌及PALN转移患者的生存率达到50%，这一生存率与盆腔淋巴结受累患者报告的生存率相当。
