子宮頸癌手術後復發之放射線治療

RADIOTHERAPY FOR RECURRENT CERVICAL CARCINOMA AFTER SURGERY

吳錦榕(Ching-Jung Wu) ； 許文林(Wen-Lin Hsu) ； 顏上惠(Sang-Hue Yen) ； 林光大(Kuang-Tah Lin)

《中華放射線醫學雜誌》 14卷2期 (1989/06) Pp. 169-175

摘要

三軍總醫院放射腫瘤部自民國63年1月至72年6月，治療手術後復發的子宮頸癌患者104人，以接受治癒爲目的之放射線治療患者計62位。復發部位局限於陰道者有38人，陰道及骨盆腔者19人，僅在骨盆腔內者5人。治療方法包括（1）復發僅限於陰道者，於4至6星期內給3,600至5,000 cGy全骨盆遠隔放射線治療，然後再給予3,350至6,720毫克小時銫137陰道腔內近接治療。（2）復發在骨盆腔內，或陰道與骨盆腔內均有復發病灶者，則僅作骨盆遠隔放射線治療，劑量爲7至7.5星期內給予6,500至7,000 cGy。62位患者經放射線治療後，5年絕對存活率爲37％（23/62）。其中復發部位局限於陰道者爲42％（16/38），復發部位在陰道與骨盆腔內均有者爲31.6％（6/19），復發部位僅在骨盆腔內者爲20％（1/5）。62位患者中有11人（17.7％）產生併發症。其中有9位在放射線治療後9至15個月間發生放射線直腸炎，1位在3年5個月後發生直腸陰道瘻管，另1位在2年7個月發生小便失禁的現象。本文分析並討論這62位患者治療之結果及未來治療趨勢。

關鍵字

復發性子宮頸癌（recurrent cervical carcinoma） ； 放射線治療（radiotherapy） ； 遠隔治療（teletherapy） ； 近接治療（brachytherapy）

並列摘要

From January 1974 through June 1983, 104 patients were accepted by the Department of Radiation Oncology of the Tri-Service General Hospital for treatment of pelvic recurrence of a primary carcinoma of the cervix initially treated by surgery. A total of 62 patients treated with curative intent radiotherapy for pelvic recurrence were included in this study. The site of recurrence of thirty-eight patients (61%) was limited to the vagina, 19 patients (31%) both to the vagina and pelvis, 5 patients (8%) to the pelvis only. The patients divided into two groups and given different treatment of radiotherapy. In the first group, each patient whose recurrent site was limited to the vagina, was delivered 3,600-5, 000 cGy in 4-6 weeks to whole pelvis plus 3,350-6.720 mghrs Cs-137 intravaginal therapy. In the second group, each patient whose recurrent site was involved to the pelvis or pelvis and vagina, was delivered 6.500-7,000 cGy in 7-7.5 weeks to the pelvis. Twenty-three of 62 patients are still alive; the absolute five-year survival rate is 37%. Sixteen of 38 patients whose recurrent site were limited to the vagina are alive; the absolute five -year survival rate is 42%. Six of 19 patients whose recurrent site involved to the pelvis or pelvis and vagina are alive; the absolute five-year survival rate is 31.6%. One of 5 patients whose recurrent site involved to the pelvis only are alive; the absolute five-year survival rate is 20%. Eleven of 62 patients (17.7%) developed complications. Nine of eleven patients has had radiation proctitis nine to fifteen months after radiotherapy. One patient has had rectovaginal fistula 3 years and 5 months after radiotherapy. The other one has had incontinence of urination 2 years and 7 months after radiotherapy. We analyzed the results of these 62 patients and discussed the further tendency of treatment for recurrent cervical carcinoma after surgery.