Ito H, Shigematsu N, Kawada T, Kubo A, Isobe K, Hara R, Yasuda S, Aruga T, Ogata H
School of Medicine, Keio University, Japan.
Gynecol Oncol. 1997 Nov;67(2):154-61. doi: 10.1006/gyno.1997.4855.
This study was performed to establish the classification and the treatment modality for recurrent cervical cancer of the vaginal stump after hysterectomy.
Ninety patients with centrally recurrent cervical cancer of the vaginal stump following hysterectomy were treated with high-dose-rate intracavitary brachytherapy with or without external irradiation. The intervals between primary surgery and vaginal recurrences varied from 3 months to 36 years. Tumor size of the vaginal stump was determined by bimanual rectovaginal examination at the time of recurrence and was classified into three groups, i.e., small (no palpable tumor), medium (less than 3 cm), and large (3 cm or more).
The 10-year survival rates for all patients were 52%. Survival was greatly influenced by the tumor sizes of the vaginal stump. The 10-year survival rates of patients with small, medium, and large size tumors were 72, 48, and 0%, respectively. All patients with large size tumors died within 5 years. Of 90 patients, 75 (83%) were determined by physical examination to be free of tumor on at least one visit within 2 months of the completion of treatment (CR). The remaining 15 patients (17%) had physical findings suggestive of residual tumor (Residual). The overall 10-year survival rate for all patients with CR was 63%, compared with 10% for the patients with Residual (P < 0.0001). The incidences of distant metastases of the patients with or without local failure were 55 and 13%, respectively (P < 0.0001). The patients with local failure had significantly higher incidence of metastases. Most patients with small size tumor were treated with brachytherapy alone, and the survival rates of these patients were not improved by combination with external irradiation.
These results suggest that tumor size was a significant prognostic factor for recurrent cervical cancer of the vaginal stump. Patients with small size tumors were recommended to be treated with brachytherapy alone.
本研究旨在建立子宫切除术后阴道残端复发性宫颈癌的分类及治疗方式。
90例子宫切除术后阴道残端中央复发性宫颈癌患者接受了高剂量率腔内近距离放疗，部分联合外照射。初次手术至阴道复发的间隔时间为3个月至36年。复发时通过双合诊直肠阴道检查确定阴道残端肿瘤大小，并分为三组，即小（无可触及肿瘤）、中（小于3 cm）、大（3 cm或更大）。
所有患者的10年生存率为52%。生存情况受阴道残端肿瘤大小的显著影响。小、中、大肿瘤患者的10年生存率分别为72%、48%和0%。所有大肿瘤患者均在5年内死亡。90例患者中，75例（83%）在治疗结束后2个月内至少一次检查时经体格检查确定无肿瘤（完全缓解）。其余15例患者（17%）有提示残留肿瘤的体格检查结果（残留）。所有完全缓解患者的总体10年生存率为63%，而残留患者为10%（P<0.0001）。有或无局部失败患者的远处转移发生率分别为55%和13%（P<0.0001）。局部失败患者的转移发生率显著更高。大多数小肿瘤患者仅接受近距离放疗，联合外照射并未提高这些患者的生存率。
这些结果表明肿瘤大小是阴道残端复发性宫颈癌的重要预后因素。建议小肿瘤患者仅接受近距离放疗。
