查詢結果分析
相關文獻
- 子宮頸癌的預後因素及化學治療在子宮頸癌治療的角色
- Implications of a Failed Prospective Trial of Adjuvant Therapy after Radical Hysterectomy for Stage Ib-IIa Cervical Carcinoma with Pelvic Node Metastases
- Survival Advantages and Complications of Adjuvant Therapy in Early-Stage Cervical Cancer with Pelvic Node Metastasis
- 子宮頸癌的化學治療
- Prognostic Significance of Parametrial Involvement and/or Pelvic Lymph Node Metastasis in Cervical Cancer Stages I B. II A and II B ... A Study of 438 Cases Treated by Radical Hysterectomy and Pelvic Lymphadenectomy
- 子宮頸癌之化學治療
- Chemotherapy for Recurrent and Advanced Cervical Cancer
- A Phase Ⅱ Trial of Concurrent Chemoradiation with Weekly Cisplatin and Glutathione for Bulky Advanced Cervical Cancer
- Prophylactic Para-Aortic Radiotherapy and Concomitant Chemotherapy for Patients with Cervical Carcinoma: Preliminary Analysis of Outcome and Toxicity
- Radical Hysterectomy Alone or Combined with Neoadjuvant Chemotherapy in the Treatment of Early Stage Bulky Cervical Carcinoma
頁籤選單縮合
題名 | 子宮頸癌的預後因素及化學治療在子宮頸癌治療的角色=Prognostic Factors and Role of Chemotherapy in Cervical Cancer |
---|---|
作者 | 賴瓊慧; | 書刊名 | 中華民國癌症醫學會雜誌 |
卷期 | 16:2 2000.06[民89.06] |
頁次 | 頁9-15 |
分類號 | 417.2832 |
關鍵詞 | 子宮頸癌; 預後因素; 化學治療; 化學放射治療; 淋巴腺轉移; Cervical cancer; Prognostic factor; Chemotherapy; Chemoradiation; Lymph node metastasis; |
語文 | 中文(Chinese) |
中文摘要 | 子宮頸癌的傳統治療,在早期(第一期B及第二期A)無論採取放射治療或手術治療都可以得到平均80-85的治癒率。但是在早期的巨大腫瘤(超過四公分)的五年存活率只能達到40-70,至於第二期B至第四期通常只採取放射治療,五年的存活率大約為第二期B 50-60,第三期30-45,第四期10。高危險的早期患者及晚期患者的失敗,通常不外局部再發,區域性的淋巴轉移(骨盆及主動脈旁)和遠處轉移。整合化學治療、手術和放射治療,即所謂的多元化治療(multimodality treatment),是吾人努力突破瓶頸的一個新的途徑。但是目前無論是術前或術後,放射治療前或同步的化學治療的角色尚有許多爭議。將在文中詳細討論。 |
英文摘要 | Early-stage bulky and advanced cervicalcancers are frequently associated with higherrates of lymph node metastasis, central, regionaland distant failure. Conventionally, chemotherapy(CT) is given for palliation in distant metastasis,recurrent or advanced disease, for which situationsurgery or radiotherapy (RT) has no longer beenamenable for cure. Up to the present, cisplatinhas been considered the most active single agentfor squamous or adenocarcinoma of the cervix.Role of CT in the treatment of cervical cancercan be explored in the following aspects: (1)adjuvant CT after radical surgery; (2)neoadjuvant CT before radical surgery or RT; and(3) concurrent chemoradiation (CCRT). Adjuvant RT is usually given for high-riskearly-stage cervical cancer after radical surgery,which decreases pelvic recurrence but does notimprove overall survivals due to distantmetastasis. Several studies have reported asignificant survival benefit of adjuvant CT aloneafter radical hysterectomy and pelviclymphadenectomy (RH-PLND) in early-stagecervical cancer with pelvic node metastasis. Aphase III Gynecologic Oncology Group (GOG)study comparing RT alone versus CCRT forearly-stage high-risk (positive margins, lymphnodes, or parametrium) cervical cancer after RH-PLND has confirmed that CCRT attainssignificantly better survival than RT alone,However, the 5-year survival rate in those whoreceived RT was 60, which is not different fromthose without adjuvant therapy in other series.Based on our previous studies, CT alone may be enough for those with node-positive andmargin/parametrium-free to accomplish acomparable survival benefit of CCRT yet lessmorbidity. That will be awaited for the TaiwanCollaborative Oncology Group (TCOG) trial toprove. Quite a few studies have negated the benefitof neoadjuvant CT prior to definitive RT.Nevertheless the role of neoadjuvant CT prior toradical surgery warrants further investigations. Ina recently published randomized trial from ourinstitution, we compared neoadjuvant CT plusRH-PLND versus primary RT. Both arms werefound comparable in respect to progression-freeand overall survival. In contrast to the trial by Sardi et al., in which RH-PLND plus RT (2treatments) was compared to neo adjuvant CTplus RH-PLND plus RT (3 treatments) and thelatter was found better than the former, we usedonly 2 treatments versus one treatment andobtained comparable survivals. Up to 1999, three prospective controlledstudies have proven that CCRT with cisplatin orcombined with 5-FU is better than RT alone orRT plus hydroxyurea in previously untreatedadvanced cervical carcinoma. In one of ourstudies, we have also demonstrated the benefit ofCCRT in salvage of recurrent cervical cancerafter RH-PLND. Regarding prognostic factors, lymph nodemetastasis, parametrial extension, lymphaticpermeation, and bulky tumor ... etc are frequentlyreported as risk factors for recurrence. Pelvicnode metastasis implicates 40 to 50 reduce in five year survivals. The role of DNA flowcytometry in the prognosis of cervical cancer iscontroversial. In our previous studies, we foundlhat using a cutoff of DNA index (Dl) of 1.3rendered Dl an independent prognostic factor inall cervical cancers as a whole, or amongadenocarcinomas or those with lymph nodemetastasis. Among the variables that could beassessed before treatment, depth of cervicalstromal invasion (determined by magneticresonance imaging), clinical stage, tumor size, grade of differentiation, and Dl were independentpredictors of outcome in multivariate analysis (Cox regression) of 891 patients with Stage IB orII cervical carcinomas. The model for prognosisclassification may be useful for patient selectionand stratification when future prospective trialsare designed. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。