Preoperative chemoradiation for advanced vulvar cancer: A phase II study of the gynecologic oncology group
Preoperative chemoradiation for advanced vulvar cancer: A phase II study of the gynecologic oncology group
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DOI：
10.1016/s0360-3016(98)00193-x
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发表时间：
1998-08-01
影响因子：
7
通讯作者：
Olt, G
中科院分区：
文献类型：
--
作者：
Moore, DH;Thomas, GM;Olt, G
目的：为了确定使用术前放化疗的可行性，以避免T-3原发性肿瘤患者需要进行更彻底的手术，或T-4原发性肿瘤患者需要进行盆腔清除术，不适合通过标准根治性外阴切除术切除，方法和材料：73例可评估的临床III-IV期外阴鳞状细胞癌患者参加了这项前瞻性，多机构试验。治疗包括计划的顺铂/5-氟尿嘧啶和放射治疗，随后手术切除残留的原发性肿瘤加双侧腹股沟-股淋巴结清扫。放射治疗通过前-后-后-前（AP-PA）野以170 cGy的剂量分次输送至原发性肿瘤体积，剂量为4760 cGy。不能手术的腹股沟淋巴结患者接受了原发性外阴肿瘤、腹股沟-股骨和下盆腔淋巴结的放化疗。结果：7例患者未接受治疗后手术：病情恶化（2例）;其他疾病（1例）;不可切除的残留肿瘤（2例）;患者拒绝（2例）。放化疗后，33/71（46.5%）患者在计划手术时没有可见的外阴癌，38/71例患者在计划手术时没有可见的外阴癌。53.5%的患者在手术时有大体残留癌，后38例患者中有5例切缘阳性，并接受了：外阴进一步放射治疗（3例患者）;广泛局部切除和阴道切除术，需要结肠造口术（1例患者）;未进一步治疗（1例患者）。采用术前分程放疗，每日2次联合顺铂和5-氟尿嘧啶化疗的策略，仅2/71例（2.8%）有不可切除的残留病灶。只有3例患者不能保留泌尿和/或胃肠道功能。毒性是可以接受的，最常见的不良反应是放化疗的急性皮肤反应和手术伤口并发症。结论：术前放化疗在晚期外阴鳞状细胞癌中是可行的，并可能减少更根治性手术的需要，包括原发性盆腔清除术。(C)1998年爱思唯尔科学公司
Purpose: To determine the feasibility of using preoperative chemoradiotherapy to avert the need for more radical surgery for patients with T-3 primary tumors, or the need for pelvic exenteration for patients with T-4 primary tumors, not amenable to resection by standard radical vulvectomy,Methods and Materials: Seventy-three evaluable patients with clinical Stage III-IV squamous cell vulvar carcinoma were enrolled in this prospective, multi-institutional trial. Treatment consisted of a planned split course of concurrent cisplatin/5-fluorouracil and radiation therapy followed by surgical excision of the residual primary tumor plus bilateral inguinal-femoral lymph node dissection. Radiation therapy was delivered to the primary tumor volume via anterior-posterior-posterior-anterior (AP-PA) fields in 170-cGy fractions to a dose of 4760 cGy. Patients with inoperable groin nodes received chemoradiation to the primary vulvar tumor, inguinal-femoral and lower pelvic lymph nodes,Results: Seven patients did not undergo a post-treatment surgical procedure: deteriorating medical condition (2 patients); other medical condition (1 patient); unresectable residual tumor (2 patients); patient refusal (2 patients). Following chemoradiotherapy, 33/71 (46.5%) patients had no visible vulvar cancer at the time of planned surgery and 38/71 (53.5%) had gross residual cancer at the time of operation, Five of the latter 38 patients had positive resection margins and underwent: further radiation therapy to the vulva (3 patients); wide local excision and vaginectomy necessitating colostomy (1 patient); no further therapy (1 patient). Using this strategy of preoperative, split-course, twice-daily radiation combined with cisplatin plus 5-fluorouracil chemotherapy, only 2/71 (2.8%) had residual unresectable disease. In only three patients was it not possible to preserve urinary and/or gastrointestinal continence, Toxicity was acceptable, with acute cutaneous reactions to chemoradiotherapy and surgical wound complications being the most common adverse effects,Conclusion: Preoperative chemoradiotherapy in advanced squamous cell carcinoma of the vulva is feasible, and may reduce the need for more radical surgery including primary pelvic exenteration. (C) 1998 Elsevier Science Inc.