宫颈癌标准治疗选择课件

3/1/2024Dr.XiaohuaWu1StandardTreatmentOptions

forCervicalCancer

FIGO:StagingclassificationsandclinicalpracticeguidelinesofCervicalcancerNationalCancerInstituteM.D.AndersonCancerCenterPracticalGynecologicOncology4thEdition3/1/2024Dr.XiaohuaWu2CancersoftheFemaleReproductiveTract:

WorldwideStatistics1

Ferlayetal.)

CancerNewCasesDeathsCervical470,000230,000Endometrial189,00045,000Ovarian192,000114,000USANorthernEuropeSouthernEurope23,80010,00010,20015,6007,2006,2003/1/2024Dr.XiaohuaWu31974-2000上海市居民妇科肿瘤发病率

上海市肿瘤研究流行病研究室年报告3/1/2024Dr.XiaohuaWu43/1/2024Dr.XiaohuaWu53/1/2024Dr.XiaohuaWu6TreatmentOptionOverview

FiverandomizedphaseIIItrialshaveshownanoverallsurvivaladvantageforcisplatin-basedtherapygivenconcurrentlywithradiationtherapy,[1-6]while1trialexaminingthisregimendemonstratednobenefit.[7]Theriskofdeathfromcervicalcancerwasdecreasedby30%to50%byconcurrentchemoradiation.Basedontheseresults,strongconsiderationshouldbegiventotheincorporationofconcurrentcisplatin-basedchemotherapywithradiationtherapyinwomenwhorequireradiationtherapyfortreatmentofcervicalcancer.[1-8]3/1/2024Dr.XiaohuaWu7TreatmentOptionOverviewSurgeryandradiationtherapyareequallyeffectiveforearly-stagesmall-volumedisease.[9]Youngerpatientsmaybenefitfromsurgeryinregardtoovarianpreservationandavoidanceofvaginalatrophyandstenosis.Patternsofcarestudiesclearlydemonstratethenegativeprognosticeffectofincreasingtumorvolume.Therefore,treatmentmayvarywithineachstageascurrentlydefinedbyFIGO,andwilldependontumorbulkandspreadpattern.[10]3/1/2024Dr.XiaohuaWu8TreatmentOptionOverviewTherapyofpatientswithcancerofthecervicalstumpiseffective,yieldingresultscomparabletothoseseeninpatientswithanintactuterus.[11]Duringpregnancy,notherapyiswarrantedforpreinvasivelesionsofthecervix,includingcarcinomainsitu,althoughexpertcolposcopyisrecommendedtoexcludeinvasivecancer.Treatmentofinvasivecervicalcancerduringpregnancydependsonthestageofthecancerandgestationalageatdiagnosis.3/1/2024Dr.XiaohuaWu93/1/2024Dr.XiaohuaWu103/1/2024Dr.XiaohuaWu113/1/2024Dr.XiaohuaWu12临床分期检查方法3/1/2024Dr.XiaohuaWu13SurgicalStagingPretreatmentsurgicalstagingisthemostaccuratemethodtodetermineextentofdisease.Becausethereislittleevidencetodemonstrateoverallimprovedsurvivalwithroutinesurgicalstaging,itusuallyshouldbeperformedonlyaspartofaclinicaltrial.Pretreatmentsurgicalstaginginbulky,butlocallycurable,diseasemaybeindicatedinselectcaseswhenanonsurgicalsearchformetastaticdiseaseisnegative.IfabnormalnodesaredetectedbyCTscanorlymphangiography,fineneedleaspirationshouldbenegativebeforeasurgicalstagingprocedureisperformed.3/1/2024Dr.XiaohuaWu14腹主动脉旁淋巴结CT阴性患者中生存率曲线与PET扫描结果的关系

JClinOncol2001;19:3745–3749.)3/1/2024Dr.XiaohuaWu153/1/2024Dr.XiaohuaWu163/1/2024Dr.XiaohuaWu173/1/2024Dr.XiaohuaWu18Stage0CervicalCancer

Standardtreatmentoptions:

Methodstotreatectocervicallesionsinclude:Loopelectrosurgicalexcisionprocedure(LEEP).[7,8]Lasertherapy.[9]Conization.Cryotherapy.[10]Whentheendocervicalcanalisinvolved,laserorcold-knifeconizationmaybeusedforselectedpatientstopreservetheuterusandavoidradiationtherapyand/ormoreextensivesurgery.Totalabdominalorvaginalhysterectomyisanacceptedtherapyforthepostreproductiveagegroupandisparticularlyindicatedwhentheneoplasticprocessextendstotheinnerconemargin.Formedicallyinoperablepatients,asingleintracavitaryinsertionwithtandemandovoidsfor5,000milligramhours(8,000cGyvaginalsurfacedose)maybeused.[11]3/1/2024Dr.XiaohuaWu19对异常Pap

涂片或活检示微小浸润癌处理步骤

Pap涂片异常或钳取活检“微小浸润癌”锥切活检微小浸润≤5mm切缘阴性ECC阴性ECC阴性切缘和/或ECC示非典型增生ⅠA1期无广泛LVSI如有生育愿望者锥切筋膜外子宫切除再次锥切活检如锥切不便行改良RH±盆腔淋巴结切除术广泛LVSI的ⅠA1期ⅠA2期如有生育愿望者盆腔淋巴结切除加锥切，或广泛宫颈切除改良RH和盆腔淋巴结切除3/1/2024Dr.XiaohuaWu20StageIACervicalCancer

Equivalenttreatmentoptions:

Intracavitaryradiationalone:Ifthedepthofinvasionislessthan3millimetersandnocapillarylymphaticspaceinvasionisnoted,thefrequencyoflymphnodeinvolvementissufficientlylowthatexternalbeamradiationisnotrequired.Oneor2insertionswithtandemandovoidsfor6,500to8,000milligramhours(10,000-12,500cGyvaginalsurfacedose)arerecommended.[4]Radiationshouldbereservedforwomenwhoarenotsurgicalcandidates.3/1/2024Dr.XiaohuaWu21Ⅰ期早Ⅱ期（阴道前壁侵犯）除外根治性子宫切除盆腔淋巴结切除切除任何增大腹主动脉旁淋巴结淋巴结阴性高危险（GOG分数>120）多个阳性淋巴结或增大阳性淋巴结淋巴结阴性低危险观察小野盆腔放疗延伸野放疗顺铂周疗3/1/2024Dr.XiaohuaWu22StageIIBCervicalCancer

StageIIICervicalCancer

StageIVACervicalCancer

Radiationtherapypluschemotherapy:Intracavitaryradiationandexternal-beampelvicirradiationcombinedwithcisplatinorcisplatin/fluorouracil.[7-12]3/1/2024Dr.XiaohuaWu23ⅡB-ⅣA宫颈癌腹、盆腔CT盆、腹腔阴性盆腔或腹腔淋巴结≥1.5cm附件包块胸部CT胸部CT阴性胸部CT阳性切除附件包块肿大淋巴结腹膜外切除延伸野放疗和DDP周疗姑息性盆腔放疗预防性延伸野放疗和DDP周疗3/1/2024Dr.XiaohuaWu24RecurrentCervicalCancer

Standardtreatmentoptions:

Forrecurrenceinthepelvisfollowingradicalsurgery,radiationincombinationwithchemotherapy(fluorouracilwithorwithoutmitomycin)maycure40%to50%ofpatients.[3]Chemotherapycanbeusedforpalliation.Testeddrugsinclude: