Perioperative treatments for stage IB-IIB uterine cervical cancer
Perioperative treatments for stage IB-IIB uterine cervical cancer
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IB-IIB期宫颈癌的围手术期治疗
DOI：
10.1093/jjco/hyz200
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发表时间：
2020
影响因子：
2.4
通讯作者：
Yaegashi Nobuo
中科院分区：
文献类型：
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作者：
Shimada Muneaki;Tokunaga Hideki;Kobayashi Hiroaki;Ishikawa Mitsuya;Yaegashi Nobuo
日本妇科肿瘤学会指南建议，对于不仅IB1/IIA1期，而且IB2、IIA2和IIB期的患者，以根治性子宫切除术为基础的方法或包括同步放化疗在内的最终放射治疗是主要治疗方法。根据手术标本的病理结果，根治性子宫切除术患者被分为三个复发风险组，即低风险组、中风险组和高风险组。虽然一些作者报道了辅助化疗对中/高风险患者的有效性，但放射治疗是根治性子宫切除术后病理风险患者的标准辅助治疗。对于IB2-IIB期患者，新辅助化疗后的根治性子宫切除术是否有益，目前尚不确定。最近，随机的III期研究显示，与同期的放化疗相比，新辅助化疗后的根治性子宫切除术并不能提高IB2-IIB期患者的存活率。大多数IB2-IIB期患者在根治性子宫切除术后需要辅助放射治疗。根治性子宫切除术后辅助性放射治疗的多模式策略不仅与生活质量受损有关，而且还与成本-效果冲突有关。因此，一些作者探讨了在IB2-IIB期宫颈癌根治性子宫切除术前/后化疗的多模式策略的意义。根治性子宫切除术/围手术期化疗的综合治疗策略要求根治性子宫切除术治愈率高、围手术期化疗有效率高、围手术期并发症少。因此，妇科肿瘤学家必须在治疗前对患者进行严格的检查，并判断是否适合IB-IIB期宫颈癌患者的根治性子宫切除术或最终放疗。
Japan Society of Gynecologic Oncology guidelines recommended either radical hysterectomy-based approach or the definitive radiotherapy including concurrent chemoradiotherapy as primary treatment for patients with not only stage IB1/IIA1, but also stages IB2, IIA2 and IIB. Based on pathological findings of surgical specimens, patients who underwent radical hysterectomy are divided into three recurrent-risk groups, low-risk, intermediate, and high-risk groups. Although some authors reported the usefulness of adjuvant chemotherapy for intermediate/high-risk patients, radiotherapy was standard adjuvant treatment for pathological-risk patients after radical hysterectomy. It has been uncertain whether neoadjuvant chemotherapy followed by radical hysterectomy is beneficial for stage IB2–IIB patients. Recently, the randomized phase III study revealed that neoadjuvant chemotherapy followed by radical hysterectomy failed to improve survival of stage IB2–IIB patients compared to concurrent chemoradiotherapy. Majority of stage IB2–IIB patients are required adjuvant radiotherapy after radical hysterectomy. The multimodality strategy consisting of radical hysterectomy followed by adjuvant radiotherapy is associated with not only impaired quality of life, but also conflicting of cost-effectiveness. Thereby, some authors investigated the significance of multimodality strategy consisting of chemotherapy before/after radical hysterectomy for stage IB2–IIB cervical cancer. Multimodality strategy consisting of radical hysterectomy/perioperative chemotherapy needs higher curability of radical hysterectomy, higher response to perioperative chemotherapy and less perioperative complications. Consequently, gynecologic oncologists have to examine the patients strictly before treatment and judge whether radical hysterectomy-based approach or definitive irradiation is appropriate for the patient with stage IB–IIB cervical cancer.