Höckel M, Knapstein P G, Hohenfellner R, Rösler H P, Kutzner J
Klinik für Geburtshilfe und Frauenkrankheiten, Johannes-Gutenberg-Universität Mainz.
Geburtshilfe Frauenheilkd. 1993 Mar;53(3):169-76. doi: 10.1055/s-2007-1023659.
CORT has been developed to treat recurrent gynaecological malignancies infiltrating the pelvic wall unilaterally. The surgical part consists of: (i) staging laparotomy/lymphadenectomy, (ii) maximum tumour resection at the pelvic wall and exenteration of infiltrated central pelvic organs, (iii) implantation of guiding tubes on the residual tumour/tumour bed on the pelvic wall, (iv) pelvic wall plasty with muscle, musculocutaneous and omentum flaps, (v) operative reconstruction of bowel, bladder and perineo-vulvo-vaginal functions. Radiation is performed as interstitial high dose rate brachytherapy through the implanted tubes. Patients without prior pelvic irradiation receive in addition, whole pelvis teletherapy. CORT has been evaluated in a prospective phase I and II trial at the University of Mainz. Within a 3-year period, 21 patients with pelvic wall recurrences from various gynaecological primary tumours were treated. Seventeen patients had been irradiated as (part of) the previous therapy with a median total mid-pelvic dose of 65 Gy (range 40-100 Gy). There was no operative mortality. Five patients developed complications necessitating surgical intervention. One patient died from fatal thromboembolism 6 months after CORT without evidence of tumour progression. In 14 patients, local tumour control has been achieved. After a median follow-up period of 27 months (range 6-38 months) Kaplan-Meier life table analysis revealed an actuarial survival probability of 55% (recurrence-free 49%). We conclude from these preliminary results, that the CORT procedure for the treatment of pelvic wall recurrences is feasible and may lead to encouraging therapeutic success in selected patients, whose situation had been hopeless so far.
CORT已被开发用于治疗单侧浸润盆腔壁的复发性妇科恶性肿瘤。手术部分包括：（i）分期剖腹探查术/淋巴结切除术，（ii）盆腔壁最大程度肿瘤切除及浸润的盆腔中央器官切除，（iii）在盆腔壁残留肿瘤/肿瘤床植入引导管，（iv）用肌肉、肌皮瓣和网膜瓣进行盆腔壁整形，（v）肠道、膀胱及会阴-外阴-阴道功能的手术重建。通过植入的导管进行组织间高剂量率近距离放射治疗。未接受过盆腔放疗的患者还需接受全盆腔远距离放疗。CORT已在美因茨大学进行的一项前瞻性I期和II期试验中得到评估。在3年时间里，治疗了21例来自各种妇科原发肿瘤的盆腔壁复发患者。17例患者曾接受过放疗，作为先前治疗的一部分，盆腔中部中位总剂量为65 Gy（范围40 - 100 Gy）。无手术死亡病例。5例患者出现需要手术干预的并发症。1例患者在CORT治疗后6个月死于致命性血栓栓塞，无肿瘤进展证据。14例患者实现了局部肿瘤控制。中位随访期27个月（范围6 - 38个月）后，Kaplan - Meier生存表分析显示精算生存概率为55%（无复发生存率49%）。我们从这些初步结果得出结论，CORT手术治疗盆腔壁复发是可行的，对于目前病情绝望的特定患者可能会取得令人鼓舞的治疗成功。
