宮頸癌標(biāo)準(zhǔn)治療選擇課件

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上海市居民婦科腫瘤發(fā)病率

上海市腫瘤研究流行病研究室年報(bào)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臨床分期檢查方法3/1/2024Dr.XiaohuaWu13SurgicalStagingPretreatmentsurgicalstagingisthemostaccuratemethodtodetermineextentofdisease.Becausethereislittleevidencetodemonstrateoverallimprovedsurvivalwithroutinesurgicalstaging,itusuallyshouldbeperformedonlyaspartofaclinicaltrial.Pretreatmentsurgicalstaginginbulky,butlocallycurable,diseasemaybeindicatedinselectcaseswhenanonsurgicalsearchformetastaticdiseaseisnegative.IfabnormalnodesaredetectedbyCTscanorlymphangiography,fineneedleaspirationshouldbenegativebeforeasurgicalstagingprocedureisperformed.3/1/2024Dr.XiaohuaWu14腹主動(dòng)脈旁淋巴結(jié)CT陰性患者中生存率曲線與PET掃描結(jié)果的關(guān)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對(duì)異常Pap

涂片或活檢示微小浸潤(rùn)癌處理步驟

Pap涂片異?；蜚Q取活檢“微小浸潤(rùn)癌”錐切活檢微小浸潤(rùn)≤5mm切緣陰性ECC陰性ECC陰性切緣和/或ECC示非典型增生ⅠA1期無廣泛LVSI如有生育愿望者錐切筋膜外子宮切除再次錐切活檢如錐切不便行改良RH±盆腔淋巴結(jié)切除術(shù)廣泛LVSI的ⅠA1期ⅠA2期如有生育愿望者盆腔淋巴結(jié)切除加錐切，或廣泛宮頸切除改良RH和盆腔淋巴結(jié)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（陰道前壁侵犯）除外根治性子宮切除盆腔淋巴結(jié)切除切除任何增大腹主動(dòng)脈旁淋巴結(jié)淋巴結(jié)陰性高危險(xiǎn)（GOG分?jǐn)?shù)>120）多個(gè)陽(yáng)性淋巴結(jié)或增大陽(yáng)性淋巴結(jié)淋巴結(jié)陰性低危險(xiǎn)觀察小野盆腔放療延伸野放療順鉑周療3/1/2024Dr.XiaohuaWu22StageIIBCervicalCancer

StageIIICervicalCancer

StageIVACervicalCancer

Radiationtherapypluschemotherapy:Intracavitaryradiationandexternal-beampelvicirradiationcombinedwithcisplatinorcisplatin/fluorouracil.[7-12]3/1/2024Dr.XiaohuaWu23ⅡB-ⅣA宮頸癌腹、盆腔CT盆、腹腔陰性盆腔或腹腔淋巴結(jié)≥1.5cm附件包塊胸部CT胸部CT陰性胸部CT陽(yáng)性切除附件包塊腫大淋巴結(jié)腹膜外切除延伸野放療和DDP周療姑息性盆腔放療預(yù)防性延伸野放療和DDP周療3/1/2024Dr.XiaohuaWu24RecurrentCervicalCancer

Standardtreatmentoptions:

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