Mitsuhashi N, Takahashi M, Nozaki M, Yamakawa M, Takahashi T, Sakurai H, Hayakawa K, Niibe H
Department of Radiology and Radiation Oncology, Gunma University School of Medicine, Japan.
Int J Radiat Oncol Biol Phys. 1994 Jul 30;29(5):975-82. doi: 10.1016/0360-3016(94)90391-3.
A retrospective analysis was performed to evaluate external beam therapy and three brachytherapy fractions for patients with squamous cell carcinoma of the uterine cervix, compared with those with other histological types.
Three hundred and twenty-two patients with carcinoma of the uterine cervix received external pelvic irradiation combined with three sessions of low dose rate intracavitary irradiation within 6 weeks. Two hundred and ninety-three patients had squamous cell carcinoma (SCC), whereas 29 patients had nonsquamous cell histology (N-SCC): 18 had adenocarcinoma, 5 had undifferentiated carcinoma, 4 had adenosquamous carcinoma, and 2 had adenoacanthoma. Survival rates, patterns of failure, local control rates, and complications in the patients with SCC were compared with those in the patients with N-SCC.
The 5-year overall actuarial survival rates for the patients with SCC and for those with N-SCC were: 84% and 100% in Stage I disease, 72% and 38% in Stage II disease, 52% and 17% in Stage III disease, and 29% and 0% in Stage IV disease, respectively. The 5-year cause specific survival rates for the patients with SCC in Stages I to IV disease were 100%, 87%, 72%, and 39%. Corresponding rates for the patients with N-SCC were 100%, 43%, 25%, and 0%. There was a statistically significant difference between the survival curves for two histological types in Stage II B, III B, and IV A diseases. The local control for the patients with N-SCC was worse than in the patients with SCC. The crude moderate and severe rectal complication rates (Grades 3 and 4) for the patients with SCC and for the patients with N-SCC were 7.5% and 3.4%, respectively. Only one patient with SCC developed chronic small intestinal injury in this series. We observed four patients with SCC who developed Grade 2 and four with Grade 4 urinary bladder complications.
Three sessions of intracavitary brachytherapy were a safe and effective procedure for the patients with SCC and the outcome of radiation therapy in the patients with SCC was satisfactory even in advanced cases. However, local control of N-SCC is difficult to achieve by this method and the prognosis for patients with N-SCC was significantly worse than that for patients with SCC.
进行一项回顾性分析，以评估子宫颈鳞状细胞癌患者接受外照射治疗和三次近距离放射治疗的情况，并与其他组织学类型的患者进行比较。
322例子宫颈癌患者在6周内接受盆腔外照射联合三次低剂量率腔内照射。293例为鳞状细胞癌（SCC），29例为非鳞状细胞组织学类型（N-SCC）：18例为腺癌，5例为未分化癌，4例为腺鳞癌，2例为腺棘癌。比较SCC患者和N-SCC患者的生存率、失败模式、局部控制率和并发症。
SCC患者和N-SCC患者的5年总精算生存率分别为：I期疾病中为84%和100%，II期疾病中为72%和38%，III期疾病中为52%和17%，IV期疾病中为29%和0%。I至IV期疾病的SCC患者的5年病因特异性生存率分别为100%、87%、72%和39%。N-SCC患者的相应比率分别为100%、43%、25%和0%。在IIB、IIIB和IVA期疾病中，两种组织学类型的生存曲线之间存在统计学显著差异。N-SCC患者的局部控制比SCC患者差。SCC患者和N-SCC患者的中度和重度直肠并发症粗发生率（3级和4级）分别为7.5%和3.4%。本系列中只有1例SCC患者发生慢性小肠损伤。我们观察到4例SCC患者发生2级膀胱并发症，4例发生4级膀胱并发症。
三次腔内近距离放射治疗对SCC患者是一种安全有效的方法，即使在晚期病例中，SCC患者的放射治疗结果也令人满意。然而，通过这种方法难以实现N-SCC的局部控制，N-SCC患者的预后明显比SCC患者差。
