单纯全子宫切除术后隐匿性宫颈癌放疗的临床效果

Clinical Effect of Postoperative Radiotherapy for Occult Invasive Cervical Cancer after Simple Hysterectomy

目的探讨单纯全子宫切除术后隐匿性宫颈癌(OICC)补充放疗的临床效果和不良反应。方法回顾性分析2003年1月至2016年1月首都医科大学附属北京妇产医院收治的15例OICC患者的临床资料。15例患者术后国际妇产科联盟分期为ⅠA2~ⅡA期,其中ⅠA2期4例,ⅠB1期9例,ⅠB2期1例,ⅡA1期1例,术后放疗,采用体外常规放疗±近距离腔内治疗,其中5例仅行盆腔外照射,10例行外照射+近距离腔内治疗,放疗期间有8例行同步化疗。所有患者均进行随访,随访截止至2017年1月,观察患者的复发与生存情况及近、远期并发症发生情况。结果 (1)复发与生存情况:15例患者随访时间为12~125个月,中位总生存时间为58个月,中位无瘤生存时间为50个月,有2例患者于治疗后9~18个月复发,复发患者均因肿瘤多处转移死亡;(2)近、远期并发症:10例患者出现近期并发症,包括Ⅰ~Ⅱ级直肠反应7例、Ⅰ级膀胱反应3例;远期并发症5例,包括Ⅰ~Ⅲ级直肠反应3例、Ⅱ级膀胱反应2例。结论对于OICC患者,采用体外常规放疗联合近距离腔内治疗是一种有效的补救治疗措施,近、远期并发症是可接受的。

Objective To analyze the therapeutic effect and adverse effect of salvage radiotherapy for occult invasive cervical cancer（ OICC） after simple hysterectomy. Methods Data of 15 OICC patients admitted to Beijing Obstetrics and Gynecology Hospital between Jan. 2003 and Jan. 2016 were retrospectively reviewed. All patients were staged Ⅰ A2 to ⅡA,of which the number of patients in International Federation of Aynecology and Bbstetrics stage ⅠA2,ⅠB1,ⅠB2,and ⅡA were 4,9,1,and 1,respectively. All the patients received regular external beam radiotherapy and/or brachytherapy following simple hysterectomy. 10 patients received both two aforementioned radiation treatments,and the other 5 patients received pelvic external beam radiotherapy. Of these 15 patients,8 patients underwent concurrent chemotherapy. All patients were followed up to January 2017. Recurrence,disease-free survival and short/long-term complications were investigated.Results（1）Recurrence and survival： the follow-up ranges from 12 to 125 months. Median total survival for all 15 patients was 58 months,and median disease-free survival was 50 months. 2 patients recurred in 9-18 months after therapy and died from tumor multi-metastasis.（2） Short/long-term complication： 10 patients suffered short-term complication,including stageⅠ-Ⅱ rectum toxicity（ 7 cases） and stage Ⅰ urinary bladder toxicity（ 3 cases）,while 5 patients had long-term complication,including stage Ⅰ-Ⅲ rectum toxicity（ 3 cases） and stage Ⅱ urinary bladder toxicity（ 2 cases）. Conclusion Regular external beam radiotherapy and brachytherapy could be safe and effective salvage treatments with acceptable short/long-term complication for the patients with OICC.