Pohar S, Hoffstetter S, Peiffert D, Luporsi E, Pernot M
Centre Alexis Vautrin, Nancy, France.
Int J Radiat Oncol Biol Phys. 1995 Jul 30;32(5):1455-60. doi: 10.1016/0360-3016(95)00109-C.
Radical radiotherapeutic management of vulvar cancer often incorporates brachytherapy as a portion of the treatment regimen. However, few studies using this modality alone to manage vulvar cancer have been published.
Thirty four patients were treated with iridium-192 (192Ir) brachytherapy for vulvar cancer between 1975 and 1993 at Centre Alexis Vautrin. Twenty-one patients were treated at first presentation when surgery was contraindicated or declined. Of these patients, 12 had International Federation of Gynecology and Obstetrics Classification Stage III or IV disease, 8 were Stage II, 1 was Stage I, and 1 was Stage 0. Thirteen patients were treated for recurrent disease. Paris system rules for implantation and dose prescription were followed. The median reference dose was 60 Gy (range 53 to 88 Gy). At the time of analysis, 10 of 34 patients were alive. Median follow-up in these 10 patients was 31 months (range: 21 months to 107 months). Fourteen of the 24 deaths were from causes other than vulvar cancer.
Kaplan-Meier actuarial 5-year local control was 47% (95% confidence interval (CI) = 23 to 73%) and 5-year actuarial loco-regional control was 45% (95% CI = 21 to 70%). Kaplan-Meier actuarial 5-year disease-specific survival was 56% (95% CI = 33 to 76%) and actuarial 5-year survival was 29% (95% CI = 15 to 49%). Median time to death was 14 months. Subset analysis revealed a higher actuarial 5-year local control in patients treated at first presentation than those treated for recurrence (80 vs. 19%, log rank, p = 0.04). Similarly, actuarial 5-year loco-regional control was higher in patients treated at first presentation (80 vs. 16%, log rank, p = 0.01). The two groups did not differ significantly in disease-specific or overall survival. The actuarial 5-year disease specific survival of 56% is somewhat less than the expected 5-year disease-specific survival after surgery in a group having a similar proportion of early stage, advanced stage, and recurrent vulvar cancer.
Brachytherapy is an effective treatment for patients with carcinoma of the vulva who decline surgery or in whom surgery is contraindicated.
外阴癌的根治性放射治疗通常将近距离放射治疗作为治疗方案的一部分。然而，很少有研究单独使用这种方式来治疗外阴癌。
1975年至1993年期间，34例患者在阿列克西·沃特兰中心接受了铱-192（192Ir）近距离放射治疗外阴癌。21例患者在初次就诊时接受治疗，当时手术禁忌或被拒绝。在这些患者中，12例患有国际妇产科联盟（FIGO）III期或IV期疾病，8例为II期，1例为I期，1例为0期。13例患者接受复发性疾病治疗。遵循巴黎系统的植入和剂量处方规则。中位参考剂量为60 Gy（范围53至88 Gy）。在分析时，34例患者中有10例存活。这10例患者的中位随访时间为31个月（范围：21个月至107个月）。24例死亡患者中有14例死于外阴癌以外的原因。
Kaplan-Meier法计算的5年局部控制率为47%（95%置信区间（CI）=23%至73%），5年局部区域控制率为45%（95%CI=21%至70%）。Kaplan-Meier法计算的5年疾病特异性生存率为56%（95%CI=33%至76%），5年生存率为29%（95%CI=15%至49%）。中位死亡时间为14个月。亚组分析显示，初次就诊时接受治疗的患者5年局部控制率高于复发性疾病患者（80%对19%，对数秩检验，p=0.04）。同样，初次就诊时接受治疗的患者5年局部区域控制率更高（80%对16%，对数秩检验，p=0.01）。两组在疾病特异性生存率或总生存率方面无显著差异。56%的5年疾病特异性生存率略低于一组具有相似比例的早期、晚期和复发性外阴癌患者手术后预期的5年疾病特异性生存率。
近距离放射治疗对于拒绝手术或手术禁忌的外阴癌患者是一种有效的治疗方法。
