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

　　　　　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治療， 79 位的病灶在治療結束時沒有完全消失；其 FIGO 分期為：1 位Ⅰ B，21 位Ⅱ B，3 位Ⅲ A，41 位Ⅲ B 及 13 位Ⅳ A； 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?j檢查為依據。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?j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 5 Gy 到 40 Gy 不等（中間值 18 Gy ）。 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之併發症。 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 值為 0.007。但對存活，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。
　　　　　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 Gung 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 Ⅱ A, 21 Ⅱ B, 3 Ⅲ A, 41 Ⅲ B, and 13 Ⅳ A. 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 NRT (p=0.241). 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.