Long-Term Results of Stage IB to IIB Cervical Carcinoma Treated by Preoperative Radiotherapy and Surgery

初期子宮頸癌患者手術前放射治療之長期追蹤

劉岱瑋(Dai-Wei Liu) ； 許文林(Wen-Lin Hsu) ； 任益民(Yee-Min Jen) ； 黃經民(Jing-Min Hwang) ； 趙興隆(Hsing-Lung Chao) ； 林宏益(Hon-Yi Lin) ； 林群書(Chun-Shu Lin) ； 岑榮潤(Weng-Yoon Shum)

《放射治療與腫瘤學》 12卷4期 (2005/12) Pp. 257-266

https://doi.org/10.6316/TRO/200512(4)257

摘要

目的：探討手術前放射治療合併子宮切除術對於初期子宮頸癌患者之長期治療結果及預後因子。
材料與方法：自1986年7月至1988年12月，26位初期子宮頸癌患者（依FIGO分期13位為IB，10位為ⅡA，3位為ⅡB）接受手術前放射治療合併修正型根除性子宮切除術。病患年齡中位數為49歲（介於35至65歲）。腫瘤大小中位數為5cm（介於2至7cm）。組織學型態包含有鱗狀上皮細胞癌（22位患者）、腺癌（2位患者）及小細胞癌（2位患者）。手術前放射治療為骨盆腔體外照射3600-4500cGy（中位數為3700cGy），四次子宮腔內治療共計3200cGy至A點。近接治療後兩週再以體外追加照射骨盆腔淋巴引流區域360-1260cGy（中位數為540毫格雷）。放射治療結束後4至6周接受修正型根除性子宮切除術及卵巢輸卵管切除。
結果：患者接受修正型根除性子宮切除術後，22位患者於術後病理檢查達到腫瘤完全緩解，但仍有2位患者於子宮頸旁組織出現殘存腫瘤。6位患者（佔23.1%）於手術後出現併發症。五年整體存活率及無病存活率分別為79.5%與84.3%。依據Cox多變項分析顯示：接受手術後化學治療(p=0.005)、手術後子宮頸旁組織出現殘存腫瘤(p=0.007)及患者年齡小於40歲(p=0.017)是影響整體存活之預後因素。
結論：對於初期子宮頸癌患者，特別是巨大腫瘤，手術前放射治療合併修正型根除性子宮切除術可達到與根除性子宮切除術或單純放射治療相當之治療結果。對於手術切除後子宮頸旁組織出現殘存腫瘤之患者，其預後較差。

關鍵字

子宮頸癌 ； 術前放射治療 ； 修正型根除性子宮切除術

並列摘要

Purpose: To evaluate the treatment results of preoperative radiotherapy followed by surgery and the prognostic factors in patients with stage IB to IIB cervical carcinoma.
Materials and Methods: Between July 1986 and December 1988, twenty-six patients with FIGO stage IB (13 patients), IIA (10 patients) and IIB (3 patients) cervical carcinoma were evaluated and treated at the Tri-Service General Hospital. The median age of the patients was 49 years (range 35-65). The median tumor size was 5 cm (range 2-7). The histological types were squamous cell carcinoma (22 patients), adenocarcinoma (2 patients) and small cell carcinoma (2 patients). Preoperative radiotherapy dose to whole pelvis was 3600-4500 cGy (median 3700 cGy). This was followed by 4 fractions of intracavitary brachytherapy providing 3200 cGy to point A. A boost dose of 360-1260 cGy (median 540 cGy) was given to the parametrial area. All patients underwent extrafascial hysterectomy and bilateral salpingo-oophorectomy 4 to 6 weeks after completion of radiation therapy.
Results: Twenty-two (84.6%) patients had no residual tumor after hysterectomy, but two patients (7.7%) had parametrial involvement after operation. Complications were observed in 6 (23.1%) patients, all occurred in postoperative period. Five-year overall and disease-free survival was 79.5% and 84.3%, respectively. Cox proportional hazard models demonstrated poor prognostic factors were adjuvant chemotherapy (p=0.005), parametrial involvement after operation (p=0.007) and age below 40 years old (p=0.017).
Conclusions: The results of preoperative radiotherapy and surgery showed as comparable as radical hysterectomy or radiotherapy alone, especially for bulky tumor. Residual parametrial involvement after operation remains poor prognosis.

並列關鍵字

Cervical cancer ； Preoperative radiotherapy ； Extrafascial hysterectomy