Okada M, Kigawa J, Minagawa Y, Kanamori Y, Shimada M, Takahashi M, Oishi T, Terakawa N
Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan.
Gynecol Oncol. 1998 Jul;70(1):61-4. doi: 10.1006/gyno.1998.5005.
To determine the role of radiation therapy following radical surgery in patients with cervical cancer.
A total of 104 patients with International Federation of Gynecology and Obstetrics stage IB to IIB cervical cancer who underwent radical hysterectomy and pelvic lymph node dissection at Tottori University Hospital between 1988 and 1994 were entered in this study. The criteria for postoperative radiotherapy included positive lymph node involvement, compromised surgical margin, parametrial extension, or deep stromal invasion of cervix with less than 3 mm of distance from serosa. Postoperative radiotherapy consisted of 10-20 Gy whole pelvis and an additional parametrial dose with a midline block to deliver a total of 44-50 Gy to the pelvic side wall.
Sixty-two patients (59.6%) who met the criteria received postoperative radiotherapy. Lymph node metastasis was most frequent in stage IIB followed by stage IIA and then stage IB (36.7, 22.2, and 10.7%, respectively). Parametrial extension was observed 8.7% of patients with stage IB and 27.7% of those with stage IIA. The estimated 5-year survival rate for patients undergoing surgery alone was 97.6% and that for patients receiving postoperative radiotherapy was 82.7% (P = 0.038). Multivariate analysis showed that lymph node metastasis and parametrial extension were major prognostic factor, but the survival rate did not relate to depth of stromal invasion.
Postoperative radiotherapy may improve the survival of patients with cervical cancer exhibiting lymph node metastasis or parametrial extension.
确定宫颈癌患者根治性手术后放疗的作用。
本研究纳入了1988年至1994年间在鸟取大学医院接受根治性子宫切除术和盆腔淋巴结清扫术的104例国际妇产科联盟（FIGO）分期为IB至IIB期的宫颈癌患者。术后放疗的标准包括淋巴结转移阳性、手术切缘阳性、宫旁组织受累或宫颈深层间质浸润且距浆膜层距离小于3mm。术后放疗包括全盆腔10 - 20Gy，额外给予宫旁组织剂量并使用中线挡铅，使盆腔侧壁总剂量达到44 - 50Gy。
62例（59.6%）符合标准的患者接受了术后放疗。淋巴结转移在IIB期最为常见，其次是IIA期，然后是IB期（分别为36.7%、22.2%和10.7%）。IB期患者宫旁组织受累率为8.7%，IIA期患者为27.7%。单纯手术患者的估计5年生存率为97.6%，接受术后放疗患者的5年生存率为82.7%（P = 0.038）。多因素分析显示，淋巴结转移和宫旁组织受累是主要的预后因素，但生存率与间质浸润深度无关。
术后放疗可能提高出现淋巴结转移或宫旁组织受累的宫颈癌患者的生存率。
