医学
淋巴
放射治疗
淋巴结
宫颈癌
淋巴结切除术
主动脉旁淋巴结
揭穿
近距离放射治疗
癌
外科
外照射放疗
存活率
放射科
癌症
转移
内科学
卵巢癌
病理
作者
Jonathan A. Cosin,Jeffrey M. Fowler,M. Dwight Chen,Pamela J. Paley,Linda F. Carson,Leo B. Twiggs
出处
期刊:Cancer
[Wiley]
日期:1998-06-01
卷期号:82 (11): 2241-2248
被引量:206
标识
DOI:10.1002/(sici)1097-0142(19980601)82:11<2241::aid-cncr20>3.0.co;2-t
摘要
BACKGROUND The routine use of extraperitoneal surgical staging prior to radiation therapy in patients with bulky or locally advanced cervical carcinoma remains controversial. METHODS A review was performed of 266 patients with cervical carcinoma who underwent extraperitoneal pelvic and paraaortic lymphadenectomy prior to receiving radiotherapy. Patients were divided into groups based on their lymph node status. Group A had negative lymph nodes; Group B had resected, microscopic lymph node metastases; Group C had macroscopically positive lymph nodes that were resectable at the time of surgery; and Group D had unresectable lymph nodes. All patients received standard radiotherapy utilizing external beam and brachytherapy. Patients with lymph node metastases received extended field irradiation. Survival probabilities were computed by the Kaplan-Meier product limits method with statistical significance determined by the Mantel-Cox log rank test. RESULTS Lymph node metastases were detected in 49% of patients. Five- and 10-year disease free survival rates were similar for all patients in Groups B and C. All patients in Group D recurred. There was a 10.5% incidence of severe radiation-related morbidity and a 1.1% incidence of treatment-related deaths. CONCLUSIONS Pretreatment extraperitoneal staging of patients with bulky or locally advanced cervical carcinoma may afford a survival benefit via the debulking of macroscopically positive lymph nodes without significantly increasing treatment-related morbidity or mortality. Cancer 1998;82:2241-2248. © 1998 American Cancer Society.
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