Coleman R L, Keeney E D, Freedman R S, Burke T W, Eifel P J, Rutledge F N
Department of Gynecologic Oncology, University of Texas M.D. Anderson Cancer Center, Houston 77030.
Gynecol Oncol. 1994 Oct;55(1):29-35. doi: 10.1006/gyno.1994.1242.
Patients with small recurrent cervical carcinomas following radiation therapy may be salvaged with radical hysterectomy rather than exenteration. Between 1953 and 1993, 50 patients underwent radical hysterectomy for persistent (n = 18) or recurrent (n = 32) cervical cancer after primary radiotherapy. The mean age of the cohort was 44 years (range, 23-70). Histologic types were squamous in 46, adenocarcinoma in 3, and adenosquamous in 1. Of 37 patients with staged disease, 24 had stage IB/IIA, 7 had stage IIB, 2 had stage IIIA, and 2 had stage IIIB. Combination radiotherapy, consisting of 40-45 Gy external-beam radiation plus brachytherapy (mean 6980 mg/hr), was performed in 32 patients (64%). In the 32 patients with recurrent lesions, the median interval from definitive radiotherapy to radical hysterectomy was 16 months (4-301), with 19 of these patients (60%) presenting within the first 24 months. Patients with persistent carcinomas underwent radical hysterectomy after a median observation interval of 2 months (1-4). A class II or III radical hysterectomy was performed in 39 (78%) cases. Pelvic and para-aortic lymph node samplings were performed in 39 patients (78%), including 33 (66%) who underwent complete pelvic lymphadenectomy. Among those sampled, 5 (13%) had metastatic nodal disease. All 5 patients died of disease at a median 13 months after surgery. Severe postoperative complications occurred in 21 patients (42%). The most common site of injury was the urinary tract, with 14 patients (28%) developing vesicovaginal or rectovaginal fistulae, 11 (22%) developing ureteral injuries, and 10 (20%) developing severe long-term bladder dysfunction. There was one postoperative death from sepsis among the entire population. Patients with abnormal preoperative intravenous pyelograms (P < 0.05), patients with recurrent presurgical lesions (P < 0.05), and patients with postoperative pelvic cellulitis (P < 0.01) were more likely to develop fistulae. The 5- and 10-year actuarial survival rates for all cases was 72 and 60%, respectively. Tumor size at radical hysterectomy was significantly associated with survival. Five-year actuarial survival in 12 of 44 patients (27%) with identifiable lesion diameters less than 2 cm was 90% compared with 64% in patients with larger lesions (P < 0.01). Prolonged disease-free survival occurred in 26 of 50 patients (52%) who had known disease status at follow-up, whereas recurrence after radical hysterectomy was seen in 24 patients (48%).(ABSTRACT TRUNCATED AT 400 WORDS)
接受放射治疗后复发的小宫颈癌患者可通过根治性子宫切除术而非盆腔脏器清除术来挽救。1953年至1993年间，50例患者在接受初次放疗后因持续性（n = 18）或复发性（n = 32）宫颈癌接受了根治性子宫切除术。该队列的平均年龄为44岁（范围23 - 70岁）。组织学类型为鳞状细胞癌46例，腺癌3例，腺鳞癌1例。在37例分期疾病患者中，24例为IB/IIA期，7例为IIB期，2例为IIIA期，2例为IIIB期。32例患者（64%）接受了由40 - 45 Gy体外照射加近距离放疗（平均6980毫克/小时）组成的联合放疗。在32例复发病变患者中，从确定性放疗到根治性子宫切除术的中位间隔时间为16个月（4 - 301个月），其中19例患者（60%）在最初24个月内出现复发。持续性癌患者在中位观察间隔2个月（1 - 4个月）后接受了根治性子宫切除术。39例（78%）病例进行了II类或III类根治性子宫切除术。39例患者（78%）进行了盆腔和腹主动脉旁淋巴结取样，其中33例（66%）接受了完整的盆腔淋巴结清扫术。在取样患者中，5例（13%）有淋巴结转移疾病。所有5例患者均在术后中位13个月死于疾病。21例患者（42%）发生了严重的术后并发症。最常见的损伤部位是泌尿系统，14例患者（28%）出现膀胱阴道或直肠阴道瘘，11例（22%）出现输尿管损伤，10例（20%）出现严重的长期膀胱功能障碍。整个人群中有1例因败血症术后死亡。术前静脉肾盂造影异常的患者（P < 0.05）、术前复发病变的患者（P < 0.05）以及术后盆腔蜂窝织炎的患者（P < 0.01）更易发生瘘管。所有病例的5年和10年精算生存率分别为72%和60%。根治性子宫切除时的肿瘤大小与生存率显著相关。44例可识别病变直径小于2 cm的患者中，12例（27%）的5年精算生存率为90%，而病变较大患者的生存率为64%（P < 0.01）。在随访时有已知疾病状态的50例患者中，26例（52%）出现了延长的无病生存期，而24例患者（48%）在根治性子宫切除术后复发。（摘要截短至400字）
