Sacco M, Tessa M, Rampino M, Ragona R, Origlia C, Del Mastro E, Rotta P
Dipartimento di Discipline Medico Chirurgiche, Università degli Studi, Torino.
Radiol Med. 1997 Jun;93(6):764-73.
January, 1977, to December, 1990, 311 patients with stage IB-IIA cervix carcinoma were treated at the Radiotherapy Department of the University of Turin. The distribution by stage was: 232 T1b (74.6%) and 79 T2a (25.4%). One hundred and eighty-nine patients (77% T1b-23% T2a) underwent preoperative radiotherapy, 63 patients (58% T1b-42% T2a) radiotherapy alone and 59 (85% T1b-15% T2a) postoperative radiotherapy. The first group of patients was treated according to three treatment protocols, based on different surgical procedures. During the median follow-up period of 86 months (82.6% of the patients underwent a minimum 3-year follow-up), 55 locoregional relapses (17%) and 21 extrapelvic metastases (7%) were observed. The 5-year NED survival rate and local control was 80%. The prognostic factors which significantly influenced survival in the univariate analysis, were: disease stage (p < .01), age (p < .05), the period between first symptom and therapy (p = .01), treatment protocols (radiotherapy combined with surgery versus radiation therapy alone: p < .05), residual disease after brachytherapy (p < .01), nodal status (p < .00001). In the radiotherapy alone group, the total dose influence on survival was not statistically significant (p = .12). In our series, histology and surgical procedures did not seem to influence prognosis. In the multivariate analysis, treatment protocol, age and residual disease after brachytherapy did not influence the prognosis, whereas the total dose of radiotherapy, pain (as first symptom) and Wertheim-Meigs surgery approach are prognostic factors. Severe late-effects were 17: 13 in the radiotherapy plus surgery protocol and 4 in the radiotherapy alone protocol. The incidence of major complications seems to correlate with surgical impact.
1977年1月至1990年12月，311例IB-IIA期宫颈癌患者在都灵大学放射治疗科接受治疗。分期分布为：232例T1b期（74.6%）和79例T2a期（25.4%）。189例患者（77%为T1b期，23%为T2a期）接受了术前放疗，63例患者（58%为T1b期，42%为T2a期）仅接受放疗，59例患者（85%为T1b期，15%为T2a期）接受了术后放疗。第一组患者根据三种治疗方案进行治疗，这些方案基于不同的手术程序。在中位随访期86个月期间（82.6%的患者至少接受了3年随访），观察到55例局部区域复发（17%）和21例盆腔外转移（7%）。5年无疾病生存（NED）率和局部控制率为80%。在单因素分析中，对生存有显著影响的预后因素为：疾病分期（p <.01）、年龄（p <.05）、首发症状与治疗之间的时间间隔（p =.01）、治疗方案（放疗联合手术与单纯放疗：p <.05）、近距离放疗后的残留疾病（p <.01）、淋巴结状态（p <.00001）。在单纯放疗组中，总剂量对生存的影响无统计学意义（p =.12）。在我们的系列研究中，组织学和手术程序似乎不影响预后。在多因素分析中，治疗方案、年龄和近距离放疗后的残留疾病不影响预后，而放疗总剂量、疼痛（作为首发症状）和韦特海姆-梅格斯手术方式是预后因素。严重晚期效应有17例：放疗加手术方案中有13例，单纯放疗方案中有4例。主要并发症的发生率似乎与手术影响相关。
