Greer B E, Koh W J, Stelzer K J, Goff B A, Comsia N, Tran A
Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, 98195-6460, USA.
Am J Obstet Gynecol. 1996 Apr;174(4):1141-9; discussion 1149-50. doi: 10.1016/s0002-9378(96)70656-7.
Recent anatomic and radiographic studies have indicated that standard external beam radiation portals may not adequately treat the volume at risk in patients with local-regionally advanced cervical cancer. A feasibility study was undertaken to evaluate toxicity, outcome, and patterns of failure in patients with advanced cervical cancer treated by expanded pelvic radiation fields.
Thirty-eight women with stages IIB and III cancers of the cervix confined to the pelvis were irradiated with curative intent with expanded pelvic radiation portals. Anteriorly and posteriorly, the median field length and width were 20 and 17.5 cm, respectively. Lateral fields had a median width of 16.5 cm, and the posterior border encompassed the entire sacral silhouette. The median external beam whole-pelvis dose was 4140 cGy, with overall point A dose boosted by brachytherapy to 8315 cGy.
Stage IIB patients (n = 22) had a 4-year actuarial local control rate of 70%, freedom from distant metastases rate of 62%, and disease-specific survival rate of 76%. In stage III disease (n = 16), the 4-year actuarial local control, freedom from distant metastases, and disease-specific survival rates were 80%, 48%, and 53%, respectively. Radiographically determined nodal status was an important predictor of disease-specific survival and distant metastases but not local control. The 4-year disease-specific survival rate was 40% in 11 patients with nodal disease compared with 71% in 27 node-negative patients (p < 0.01). The rate of freedom from distant metastases was 36% in node-positive patients versus 67% in node-negative cases (p < 0.01). The actuarial overall 4-year severe late complication rate was 14.8%.
This study has demonstrated that expanded fields for pelvic radiotherapy is feasible, well tolerated, and therapeutic. The pelvic field design concepts presented should be integrated into radiation oncology practice.
近期的解剖学和影像学研究表明，标准的外照射放疗野可能无法充分治疗局部区域晚期宫颈癌患者的危险体积。开展了一项可行性研究，以评估接受扩大盆腔放疗野治疗的晚期宫颈癌患者的毒性、疗效及失败模式。
38例局限于盆腔的IIB期和III期宫颈癌女性患者接受了旨在治愈的扩大盆腔放疗野照射。前后方向上，野的中位长度和宽度分别为20 cm和17.5 cm。侧野的中位宽度为16.5 cm，后边界包括整个骶骨轮廓。外照射全盆腔中位剂量为4140 cGy，通过近距离放疗将A点总剂量提升至8315 cGy。
IIB期患者（n = 22）4年精算局部控制率为70%，无远处转移率为62%，疾病特异性生存率为76%。III期疾病患者（n = 16）4年精算局部控制率、无远处转移率和疾病特异性生存率分别为80%、48%和53%。影像学确定的淋巴结状态是疾病特异性生存和远处转移的重要预测因素，但不是局部控制的预测因素。11例有淋巴结转移的患者4年疾病特异性生存率为40%，而27例无淋巴结转移患者为71%（p < 0.01）。淋巴结阳性患者无远处转移率为36%，而淋巴结阴性患者为67%（p < 0.01）。4年精算总体严重晚期并发症发生率为14.8%。
本研究表明，扩大盆腔放疗野是可行的，耐受性良好且具有治疗作用。所提出的盆腔野设计概念应纳入放射肿瘤学实践。
