Adding Radiation Dose to Incomplete-Regressed Cervical Cancer after Definitive Radiotherapy-Chang Gung Memorial Hospital's Experience

增添放射線劑量對於放療後子宮頸殘餘腫瘤之影響

梁爲民(Wai-Man Leung) ； 洪志宏(Ji-Hong Hong) ； 李心馨(Shin-Shin Lee) ； 王俊傑(Chun-Chieh Wang) ； 湯國政(Simon G. Tang)

《放射治療與腫瘤學》 4卷3期 (1997/09) Pp. 203-210

https://doi.org/10.6316/TRO/199704(3)203

摘要

目的：評估增添放射線治療劑量對子宮頸癌放射後殘餘腫瘤之效果及預後分析。
材料與方法：自1979至1988年間，本院有552位子宮頸癌患者接受完整的放射線治療，79位的病灶在治療結束時沒有完全消失；其FIGO分期爲：1位IB，21位ⅡB，3位ⅢA，41位ⅢB及13位IVA；病理分類，74位屬上皮細胞癌，4位是腺癌及1位腺性上皮細胞癌。腫瘤之不完全消失是以病人在療程中的每週及療後4週之追蹤檢查爲依據。此79位病患，30人接受了增添放射線劑量治療(ART)剩下之49位則只繼續追蹤及觀察(NRT)。ART的方法是採取一般之體外治療、近接治療或電子伸展錐治療。劑量從5Gy到40Gy不等(中間值18Gy)。
結果：ART及NRT的局部失敗率分別是93%和94%，遠端轉移則是20%及33%(p=0.241)。兩年存活率NRT有2%，ART是17%(p=0.354)。ART病人中有2位發生Grade Ⅲ及1位Grade IV之病發症。其死亡皆與併發症無關。ART可延緩子宮頸殘餘腫瘤之惡化，p值爲0.007。但存活，局部及遠端之控制則無明顯效果。
結論：子宮頸癌放射治療後仍有殘餘腫瘤時。ART並不能改善其預後。但對病灶之持續惡化有延緩作用。因此增添放射線劑量來對付子宮頸殘餘腫瘤方法，仍有待改進。

關鍵字

子宮頸癌 ； 放射線治療 ； 殘餘病灶 ； 增添放射線冶療劑量

並列摘要

Purpose: This study is to analyze the prognosis and evaluate the effect of additional radiation dose to incomplete-regressed cervical cancer after definitive radiotherapy.
Materials and Methods: From 1979-1988, 552 cervical carcinoma patients were treated with definitive radiotherapy at Chang Sung Memorial Hospital (CGMH), Taiwan. After the completion of treatment, 79 lesions showed incomplete regression; among them, 74 were squamous cell carcinoma, 4 were adenocarcinoma, and 1 was adenosquamous carcinoma. There were one stage ⅡA, 21 ⅡB, 3 ⅢA, 41 ⅢB, and 13 IVA. Incomplete regression of tumor was defined as having palpable or visible disease noted through out the treatment course and at the time of follow-up four weeks after the completion of treatment. Thirty patients received additional radiotherapy (ART), and 49 received no further therapy (NRT). ART was delivered by external beam, brachytherapy or electron cone. Dose ranged from 5 Gy to 40 Gy, (median 18 Gy). Minimal follow-up was one year.
Results: We observed similar local failures in ART and NRT groups (93% and 94%, respectively). The incidence of distant metastasis were 20% and 33% respectively for ART and NAT (p=0.24l). Overall survival at 2 years was 2% for NRT, and 17% for patients received ART (p=0.354). There were two grade Ⅲ and one grade IV complications in patients received ART, but their death was due to cancer, not to complication. ART did delay the progression of residual tumor with a p-value of 0.007, yet it had no beneficial gain in terms of survival, local and distal control.
Conclusions: For incomplete-regressed cervical cancer after standard radiotherapy, ART cannot improve their outcome of survivals and tumor control but may delay the residual tumor's progression. Therefore the ultimal ways of ART to treat incomplete-regressed cervical cancer deserve further investigation.

並列關鍵字

cervical cancer ； radiotherapy ； residual lesion ； additional radiation dose