Treatment of cervical cancer with adjuvant chemotherapy versus adjuvant radiotherapy after radical hysterectomy and systematic lymphadenectomy
Treatment of cervical cancer with adjuvant chemotherapy versus adjuvant radiotherapy after radical hysterectomy and systematic lymphadenectomy
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DOI：
10.1111/j.1447-0756.2008.00739.x
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发表时间：
2008-08-01
影响因子：
1.6
通讯作者：
Sakuragi, Noriaki
中科院分区：
文献类型：
--
作者：
Hosaka, Masayoshi;Watari, Hidemichi;Sakuragi, Noriaki
目的：比较宫颈癌根治术后辅助化疗(CT)和盆腔放疗(RT)的临床疗效。方法：对1991年至2002年在北海道大学医院接受根治性子宫切除和盆腔淋巴结清扫术的125例宫颈鳞癌患者的临床资料进行回顾性分析。有复发危险因素的患者70例，包括深间质侵犯、淋巴管间隙侵犯、宫旁侵犯、淋巴结转移(LNM)和巨大肿瘤(>；=4 cm)，其中42例接受RT治疗，28例接受CT治疗。几乎所有多发LNM的患者都接受了RT。对50例无多发淋巴结转移的患者(23例RT，27例CT)也进行了分析。结果：由于放疗组多发淋巴结转移的患者较多，我们分析了50例无多发淋巴结转移的患者的无瘤生存率。3年无瘤生存率分别为82.6%和96.3%(P=0.16)。RT组术后肠梗阻的发生率明显高于CT组(P=0.007)和未治疗组(P=0.0026)。RT组排尿障碍的发生率也高于CT组(P=0.0016)和未治疗组(P=0.089)。结论：对于中危患者，CT与RT疗效相当，术后并发症较少。需要一项前瞻性随机试验来比较CT联合根治性子宫切除术和盆腔淋巴结清扫术与放疗或放化疗的疗效。
Aim: To compare the clinical efficacy focused on post-treatment morbidity between adjuvant chemotherapy (CT) and pelvic radiotherapy (RT) after radical hysterectomy for patients with cervical cancer.Methods: A total of 125 patients with cervical squamous cell carcinoma who underwent radical hysterectomy and pelvic lymphadenectomy at Hokkaido University Hospital between 1991 and 2002 were enrolled in the study for retrospective analysis. Seventy patients with recurrent risk factors, including deep stromal invasion, lymph vascular space invasion, parametrial invasion, lymph node metastasis (LNM), and bulky tumor (>= 4 cm), received adjuvant therapy; 42 were treated with RT, and 28 were treated with CT. Almost all patients with multiple LNM received RT. Analyses were also performed on a subgroup of 50 patients without multiple LNM (23 RT, 27 CT). Clinical efficacy of post-treatment morbidity and survival was evaluated.Results: Because there were more patients with multiple LNM in the RT group, we analyzed disease-free survival in 50 patients without multiple LNM. The 3-year disease-free survival rate was 82.6% with RT and 96.3% with CT (P = 0.16). Postoperative bowel obstruction was significantly more frequent in the RT group versus the CT (P = 0.007) and no-therapy (P = 0.0026) groups. Urinary disturbance was also more frequent in the RT group than in the CT (P = 0.0016) and no-therapy (P = 0.089) groups.Conclusion: CT has the equivalent therapeutic effect as RT with fewer postoperative complications for patients with intermediate risks. A prospective randomized trial is needed to compare CT combined with radical hysterectomy and pelvic lymphadenectomy to RT or chemoradiotherapy.