Factors affecting long-term outcome of irradiation in carcinoma of the vagina
Factors affecting long-term outcome of irradiation in carcinoma of the vagina
复制标题
DOI：
10.1016/s0360-3016(98)00530-6
复制
发表时间：
1999-04-01
影响因子：
7
通讯作者：
Lockett, MA
中科院分区：
文献类型：
--
作者：
Perez, CA;Grigsby, PW;Lockett, MA
目的：本文对212例经病理证实的阴道癌患者进行了回顾性分析，结果：肿瘤分期是影响预后的最重要因素，肿瘤分期是影响预后的最重要因素; 0期的10年无病生存率为94%（20例患者），80%为I期59例患者中，IIA期为55%（63例患者），IIB期为35%（34例患者），III期为38%（20例患者），IV期为0%（15例患者）。所有原位病变，除了一个控制腔内治疗。在I期疾病患者中，86%没有阴道或盆腔复发的证据;他们中的大多数接受了间质或腔内治疗或两者兼而有之，并且增加外照射并没有显着增加生存率或肿瘤控制。在IIA期（阴道旁扩展）和IIB期（宫旁受累），分别有66%和56%的肿瘤通过近距离放射治疗和外照射的联合治疗得到控制; 20例III期肿瘤中有13例（65%）在盆腔得到控制。4例IV期疾病患者（27%）盆腔无复发。远处转移的总发生率在I期为13%，在IIA期为30%，在IIB期为52%，在III期为50%，在IV期为47%。原发肿瘤或宫旁扩大区的照射剂量在获得成功结果方面相对重要。在I期疾病患者中，单独近距离放射治疗的局部肿瘤控制率（80-100%）与接受盆腔外照射的患者（78-100%）相同。在II期和III期，联合外照射和近距离放射治疗的肿瘤控制率（57-80%）优于单独使用近距离放射治疗的肿瘤控制率（33-50%）（p = 0.42）。2-3级并发症的发生率（12%）与肿瘤的分期和治疗类型有关。结论：放射治疗是阴道癌患者的有效治疗方法，特别是I期。更有效的照射技术，包括优化剂量分布相结合的外部照射和间质近距离放射治疗肿瘤超过I期，是必要的，以提高局部肿瘤控制。远处转移的高发生率强调需要早期诊断和有效的全身细胞毒性药物，以提高这些患者的生存率。(C)1999 Elsevier Science Inc.
Objective: This report evaluates prognostic and technical factors affecting outcome of patients with primary carcinoma of the vagina treated with definitive radiation therapy.Methods and Materials: A retrospective analysis was performed on records of 212 patients with histologically confirmed carcinoma of the vagina treated with irradiation.Results: Tumor stage was the most significant prognostic factor; actuarial 10-year disease-free survival was 94% for Stage 0 (20 patients), 80% for Stage I (59 patients), 55% for Stage IIA (63 patients), 35% for Stage IIB (34 patients), 38% for Stage III (20 patients), and 0% for Stage IV (15 patients). All in situ lesions except one were controlled with intracavitary therapy. Of the patients with Stage I disease, 86% showed no evidence of vaginal or pelvic recurrence; most of them received interstitial or intracavitary therapy or both, and the addition of external-beam irradiation did not significantly increase survival or tumor control. In Stage IIA (paravaginal extension) and IIB (parametrial involvement) 66% and 56% of the tumors, respectively, were controlled with a combination of brachytherapy and external-beam irradiation; 13 of 20 (65%) Stage III tumors were controlled in the pelvis. Four patients with Stage IV disease (27%) had no recurrence in the pelvis. The total incidence of distant metastases was 13% in Stage I, 30% in Stage IIA, 52% in Stage IIB, 50% in Stage III, and 47% in Stage IV. The dose of irradiation delivered to the primary tumor or the parametrial extension was of relative importance in achieving successful results. In patients with Stage I disease, brachytherapy alone achieved the same local tumor control (80-100%) as in patients receiving external pelvic irradiation (78-100%) as well. In Stage II and III there was a trend toward better tumor control (57-80%) with combined external irradiation and brachytherapy than with the latter alone (33-50%) (p = 0.42). The incidence of grade 2-3 complications (12%) correlated with the stage of the tumor and type of treatment given.Conclusion: Radiation therapy is an effective treatment for patients with vaginal carcinoma, particularly Stage I. More effective irradiation techniques, including optimization of dose distribution combining external irradiation and interstitial brachytherapy in tumors beyond Stage I, are necessary to enhance locoregional tumor control. The high incidence of distant metastases emphasizes the need for earlier diagnosis and effective systemic cytotoxic agents to improve survival in these patients. (C) 1999 Elsevier Science Inc.