Monk B J, Cha D S, Walker J L, Burger R A, Ramsinghani N S, Manetta A, DiSaia P J, Berman M L
Department of Obstetrics and Gynecology, University of California Irvine Medical Center, Orange 92668.
Gynecol Oncol. 1994 Jul;54(1):4-9. doi: 10.1006/gyno.1994.1157.
The role of adjuvant pelvic radiation following radical hysterectomy and pelvic lymph node dissection in the treatment of stage IB and IIA cervical cancer is controversial. Patients most likely to benefit from postoperative radiation include those with lesions that invade deeply into the cervical stroma, extend into the parametria, or have metastasized to regional lymph nodes. Between 1977 and 1987, 95 patients were treated with this combined regimen at the University of California Irvine Medical Center and Long Beach Memorial Medical Center, including 30 patients with deep cervical stromal invasion alone, 9 patients with parametrial extension alone, 37 patients with lymph node metastasis alone, and 19 patients with both positive nodes and parametrial extension. The estimated 5-year survival for this high-risk population was 67%. Pelvic recurrences alone occurred in 12 (13%) patients, and 14 additional patients (15%) recurred outside of the radiation field. In the node-positive group, the 5-year survival was 78% when the parametrium was not involved but decreased to 39% when parametrial extension was documented (P < 0.05). Patients with grossly involved nodes or multiple nodal metastases were also more likely to recur. Finally, the estimated 5-year survival for patients with deep cervical stromal invasion as the sole indication for radiotherapy was 73%. A retrospective analysis identified tumor grade and cell type also to be of prognostic importance. Severe complications attributable to radiation combined with radical surgery included two small bowel obstructions and one urinary tract fistula. These data suggest that radical hysterectomy, pelvic lymphadenectomy, and adjuvant radiotherapy produce favorable survival results with limited morbidity in patients with high-risk cervical cancer independent of node status except in that subset of patients with both occult parametrial spread and nodal metastasis.
根治性子宫切除术和盆腔淋巴结清扫术后辅助盆腔放疗在IB期和IIA期宫颈癌治疗中的作用存在争议。最有可能从术后放疗中获益的患者包括那些病变深度浸润宫颈间质、侵犯宫旁组织或已转移至区域淋巴结的患者。1977年至1987年期间，加利福尼亚大学欧文医学中心和长滩纪念医学中心对95例患者采用了这种联合治疗方案，其中包括30例仅宫颈间质深度浸润的患者、9例仅宫旁组织受累的患者、37例仅发生淋巴结转移的患者以及19例同时有阳性淋巴结和宫旁组织受累的患者。该高危人群的估计5年生存率为67%。仅盆腔复发发生在12例（13%）患者中，另有14例（15%）患者在放疗野之外复发。在淋巴结阳性组中，当宫旁组织未受累时，5年生存率为78%，但当记录到宫旁组织受累时，5年生存率降至39%（P<0.05）。有明显受累淋巴结或多发淋巴结转移的患者也更易复发。最后，以宫颈间质深度浸润作为放疗唯一指征的患者，其估计5年生存率为73%。一项回顾性分析发现肿瘤分级和细胞类型也具有预后意义。放疗联合根治性手术导致的严重并发症包括2例小肠梗阻和1例尿道瘘。这些数据表明，对于高危宫颈癌患者，根治性子宫切除术、盆腔淋巴结切除术和辅助放疗可产生良好的生存结果，发病率有限，与淋巴结状态无关，但不包括那些同时有隐匿性宫旁组织扩散和淋巴结转移的患者亚组。
