This study investigates the impact of insufficient common iliac lymph node (CIN) irradiation on treatment outcomes in patients with stage IB2-IIB cervical cancer receiving concurrent chemoradiotherapy (CCRT). We retrospectively analyzed 68 patients with Federation of Gynecology and Obstetrics stage IB2-IIB, treated with weekly cisplatin-based CCRT from 2008 to 2018. Patients received external-beam whole pelvic radiotherapy (WPRT) and concurrent cisplatin chemotherapy, followed by high-dose-rate brachytherapy. The WPRT upper border was at L4-5 in 61 patients and L3-4 in 7 patients. Thirty-seven patients had the CIN area fully included (full-CIN group), while 31 had partial inclusion (partial-CIN group). Recurrence rates and survival outcomes were analyzed over a median follow-up of 111 months. Patient characteristics and the irradiated dose were comparable. Treatment failure occurred in three patients (8.1%) in the full-CIN group and in six patients (19.4%) in the partial-CIN group, with CIN and para-aortic lymph node recurrence in two and one patients, respectively. The 5-year cumulative recurrence rate was 0% for the full-CIN group and 11.4% for the partial-CIN group (p= 0.04). Cause-specific survival was 100% vs. 87.1% (p= 0.025), and the overall survival was 94.3% vs. 87.1% (p= 0.44). Fully including the CIN area in WPRT is crucial for stage IB2-IIB cervical cancer. Vascular anatomical margins should be considered over vertebral landmarks.
本研究探讨了髂总淋巴结照射不足对接受同步放化疗的IB2-IIB期宫颈癌患者治疗结局的影响。我们回顾性分析了2008年至2018年间接受每周顺铂方案同步放化疗的68例国际妇产科联盟分期为IB2-IIB期的患者。所有患者均接受全盆腔外照射放疗联合顺铂同步化疗，后续行高剂量率近距离放疗。其中61例患者外照射上界设定于L4-5水平，7例设定于L3-4水平。37例患者髂总淋巴结区域被完全覆盖（全照射组），31例为部分覆盖（部分照射组）。中位随访111个月后分析复发率与生存结局。两组患者基线特征与照射剂量具有可比性。全照射组3例（8.1%）出现治疗失败，部分照射组6例（19.4%）失败，其中分别有2例和1例出现髂总淋巴结及腹主动脉旁淋巴结复发。全照射组5年累积复发率为0%，部分照射组为11.4%（p=0.04）。疾病特异性生存率分别为100%对87.1%（p=0.025），总生存率为94.3%对87.1%（p=0.44）。对于IB2-IIB期宫颈癌患者，在全盆腔放疗中完全覆盖髂总淋巴结区域至关重要。建议以血管解剖边界而非椎体标志作为照射野设计依据。
肿瘤(癌症)患者之家