早期子宮頸癌術後復發：危險因子初步評估及治療

Recurrent Cervical Carcinoma after Radical Hysterectomy: Preliminary Evaluation of Risk Factors and Treatment

許義勇(Yi-Yong Hsu)；劉幕台(Mu-Tai Leu)；鍾昌宏(Chang-Hung Chung)；石井宏(Ishii Hiroshi)

子宮頸癌 ； 放射治療 ； Uterus, neoplasm ； therapeutic radiology, uterus

中華放射線醫學雜誌

16卷4期（1991 / 12 / 01）

377 - 384

繁體中文

自1980年7月至1986年12月，因早期子宮頸癌術後復發，至馬偕紀念醫院放射腫瘤科接受治療的病患，總共有62位。治療方法以放射線治療為主：使用鈷60或15MV光子射線先照射全骨盆腔30至36Gy的劑量；然後再按病灶部位及範圍，或改變照野方向和大小繼續作遠隔治療，或採用高劑量率腔內近接治療，使陰道粕膜下1公分處總共接受75至80格雷的劑量。絕大多數的病人皆能作完整個療程。治療後回診，所有的病人至少追蹤檢查兩年；整體而言，有22位病人經治療後已經活過3年；其中有7位已經活過5年。54位復發病灶局限在骨盆腔的病人，有18位病灶僅位於陰道殘端者，她們的5年存活率為94%。危險因子初步分析是採術後病理切片之診斷項目為資料，以治療效果和病人存活情形為比較標準(end points)所作的分析。研究結果認為我們所選的項目，就整體而言並不影響病人預後；就個別項目來說，淋巴腺顯微轉移似乎較有影響病人預後的趨向。至於病人術後至診斷出復發病灶之無病期長短，我們認為和病人存活期長短無關，所以並不影響病人的預後。

From July 1980 to December 1986, 62 patients were treated for recurrent cervical carcinoma after radical hysterectomy at the Department of Radiation Oncology, Mackay Memorial Hospital. The radiotherapeutic dose over the whole pelvis was 30Gy to 36Gy by Co 60 unit or 15Mev. Linear Accelerator and further teletherapy with changed portal or brachytherapy of high dose rate (Co 60) followed according to location and size of the recurrence. The total vaginal one-centimeter submucosal dose was 75-80Gy. All patients were followed up at least for 2 years. Actually 22 patients survived at least for 3 years and 7 patients more than 5 years. Eighteen patients whose lesions confined to the vaginal stump had the 5-year survival rate of 94%. The preliminary evaluation of pathologic findings of radical hysterectomy; and the end points for comparison were the treatment result and survival. There was no relationship between survival and disease free interval (DFI) after surgery. In other words, DFI was not a risk factor. Lymph node micro-metastasis seemed to have more prominent influence on prognosis than other risk factors in this study.