Postoperative radiation therapy for carcinoma of the uterine cervix.
Postoperative radiation therapy for carcinoma of the uterine cervix.
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DOI：
10.1007/bf02493274
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发表时间：
2006-02-01
影响因子：
--
通讯作者：
Ito, Hisao
中科院分区：
文献类型：
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作者：
Uno, Takashi;Isobe, Koichi;Ito, Hisao
宫颈癌术后放射治疗（PORT）是针对有术后复发病理危险因素的患者进行的经验治疗。PORT的疗效主要得到回顾性研究的支持。尽管有令人信服的证据表明使用PORT可以降低盆腔复发率，但没有证据表明它最终能提高患者的生存率。局部复发，如阴道残端复发，如果早期诊断并不总是致命的。不幸的是，一些患者甚至在移植后也可能发生远处转移。PORT的积极作用也可能被联合局部治疗导致的毒性增加所抵消。这些因素模糊了PORT对宫颈癌患者的疗效。对于复发危险因素的预测价值尚未达成共识，这使得PORT对早期宫颈癌的指征在不同机构之间差异很大。今天，根据根治性子宫切除术后存在的危险因素的组合，已经努力将患者分为三个危险组。然而，在欧洲/美国和日本，根治性手术的适应症存在根本差异，突出了PORT概念的差异；欧洲/美国的“完全切除后IB-IIA期患者的辅助盆腔照射”和日本的“手术后盆腔照射，不论初始临床阶段和手术切缘状态”。因此，欧洲/美国建立的科学证据是否适用于日本的临床实践是值得怀疑的。本文的目的是通过解释临床研究结果来回顾PORT的作用。
Postoperative radiation therapy (PORT) for cervical cancer has been empirically performed for patients with pathologic risk factors for recurrence after surgery. The efficacy of PORT is mainly supported by retrospective studies. Despite convincing evidence demonstrating a reduction in pelvic recurrence rates when PORT is employed, there is no evidence that it eventually improves patient survival. Local recurrence, such as vaginal stump recurrence, is not always fatal if diagnosed earlier. Some patients, unfortunately, may develop distant metastases even after PORT. The positive effects of PORT also may be counterbalanced by increased toxicities that result from combining local therapies. These factors obscure the efficacy of PORT for cervical cancer patients. There has been no consensus on the predictive value of risk factors for recurrence, which renders indication of PORT for early-stage cervical cancer quite variable among institutions. Today, efforts have been made to divide patients into three risk groups based on the combination of risk factors present after radical hysterectomy. In Europe/USA and Japan, however, a fundamental difference exists in the indications for radical surgery, highlighting differences in the concept of PORT; "adjuvant pelvic irradiation for stage IB-IIA patients after complete resection" in Europe/USA and "pelvic irradiation after surgery irrespective of initial clinical stage and surgical margin status" in Japan. Thus, it is questionable whether scientific evidence established in Europe/USA is applicable to Japanese clinical practice. The purpose of this article is to review the role of PORT by interpreting the results of clinical studies.