Postoperative Radiation Therapy in Patients with Pathologic Risks of Stage IB to IIA Cervical Carcinoma

初期子宮頸癌之手術後放射線治療

梁頌文(Chung-Man Leung) ； 胡渝昌(Yu-Chang Hu) ； 陳建勳(Chien-Hsun Chen) ； 劉文山(Wen-Shan Liu) ； 簡婉儀(Yuen-Yee Kan) ； 張慶雄(Ching-Hsiung Chang)

《放射治療與腫瘤學》 11卷2期 (2004/06) Pp. 71-79

https://doi.org/10.6316/TRO/200411(2)71

摘要

目的：探討手術後放射線治療對於初期子宮頸癌之結果及病理預後因子。 材料與方法：自1991年4月至2000年12月，共有130位罹患子宮頸癌之病患接受根除性子宮切除術合併骨盆淋巴腺摘除術與手術後放射線治療。其中19位病患接受化學治療。所有病患於術後病理檢查發現至少有下述一項危險因子：1. 骨盆淋巴轉移、2. 淋巴轉移個數超過1個、3. 子宮旁組織侵犯、4. 血管間隙侵犯、5. 手術切緣不足、6. 原發腫瘤大於4公分、7. 多於一項危險因子。體外放射線治療給予每一位病患全骨盆腔41-54 Gy之腫瘤劑量，分次劑量為1.8 Gy。其中124位病患利用腔內近接治療給予陰道縫合緣2.5-21.5 Gy之追加劑量。 結果：五年全部存活率及無疾病存活率分別為76.5%和76.1%。6位病患發生局部復發，16位病患發生遠端轉移，7 位病患發生局部復發及遠端轉移。單變數分析的結果指出：只有血管間隙侵犯對存活率有顯著性的影響（p = 0.05）。血管間隙侵犯及多於一項危險因子與高遠端轉移發生機率相關（p = 0.05及p = 0.02）。以多因子分析而言，只有血管間隙侵犯仍然為存活率的影響因子。20位（15%）病患治療後出現後遺症：胃腸道方面有12位（9%），泌尿系統方面有8位（6%）。五年無發生後遺症機率為91%，其中10位（8%）病患有3-4級的後遺症。 結論：此研究結果，對於初期子宮頸癌病患接受根除性子宮切除術合併手術後放射線治療，能給予病患合理的存活率。但如果病患具有血管間隙侵犯或多於一項危險因子，其存活時間較短且遠端轉移發生率較高。

關鍵字

子宮頸癌 ； 手術後放射線治療 ； 預後因子

並列摘要

Purpose : To investigate the prognostic impact of pathologic risk factors and failure patterns in patients with stage IB to IIA cervical carcinoma treated with postoperative adjuvant pelvic irradiation. Material and Method : Between April 1991 to December 2000, 130 patients with FIGO IB to IIA carcinoma of the cervix were treated with radical hysterectomy, bilateral pelvic lymphadenectomy and postoperative radiation therapy. Nineteen patients received systemic chemotherapy. All the patients had at least one of the following pathologic risk factors: 1. positive pelvic nodal metastasis, 2. multiple positive lymph nodes, 3. parametrial invasion, 4. vascular space invasion, 5. positive surgical margin, 6. bulky tumor size ＞ 4 cm, 7. multiple pathologic risk factors. The radiation dose delivered to the whole pelvis range from 41-54 Gy in 1.8 Gy fractions. One hundred twenty-four patients received 2.5-21.5 Gy intracavitary brachytherapy. Results : The patients were followed for a median of 57.9 months (range: 4.1 - 129.9). The 5-year overall survival and disease free survival rate were 76.5% and 76.1%, respectively. A total of 29 (22.3%) patients developed recurrence. Six recurrences were in the pelvis alone. Sixteen patients recurred only at sites outside the pelvis. Seven patients had both pelvic and distant recurrences. We demonstrated that only vascular space invasion had significant effect on disease free survival by univariate analysis (p = 0.05). Vascular space invasion and multiple pathologic risk factors were significantly correlated with higher incidence of distant metastasis. (p = 0.05 and p = 0.02, respectively). In multivariate analysis of these factors showed that only vascular space invasion remained significant risk factors (p = 0.05). Therapeutic complications occurred in 20 (15%) patients, including gastrointestinal in 12 (9%) patients or genitourinary in 8 (6%) patients. The overall 5-year complication-free rate was 91%. Ten (8%) of those patients had grade 3 and 4 late morbidity. Conclusion : Our study suggested that postoperative radiotherapy after radical hysterectomy give reasonable survival in early stage carcinoma of the cervix. Poor survival and higher incidence of distant metastasis were observed if presence of vascular space invasion or multiple pathologic risk factors.

並列關鍵字

Cervical cancer ； Postoperative radiotherapy ； Prognostic factors