Hướng nghiên cứu hiện tại cho ung thư cổ tử cung giai đoạn khu vực tiến triển

Current Oncology Reports - Tập 5 - Trang 468-472 - 2003
Harry J. Long1
1Division of Medical Oncology, Mayo Clinic, Rochester, USA

Tóm tắt

Hóa trị xạ trị với liều cisplatin tuần hoàn hoặc sự kết hợp giữa 5-fluorouracil và cisplatin đã trở thành tiêu chuẩn điều trị cho bệnh nhân mắc ung thư cổ tử cung giai đoạn khu vực tiến triển. Các nghiên cứu gần đây được thực hiện nhằm cải thiện kế hoạch điều trị xạ trị, tăng cường oxy hóa mô, và hóa trị liệu tiền phẫu có khả năng dẫn đến những cải thiện trong việc điều trị. Xếp loại tiên lượng không phẫu thuật trước khi phẫu thuật bằng công nghệ chụp cắt lớp phát xạ positron và đánh giá hạch bạch huyết sentinel có thể dẫn đến việc xếp loại phẫu thuật hiệu quả, hoặc thậm chí là xếp loại không phẫu thuật, lập kế hoạch điều trị xạ trị chính xác hơn, và cải thiện kiểm soát tại chỗ và hệ thống với sự giảm thiểu tỷ lệ mắc bệnh ngắn hạn và dài hạn trong việc điều trị ung thư cổ tử cung giai đoạn khu vực tiến triển. Các thử nghiệm lâm sàng ngẫu nhiên, có thiết kế tốt là cần thiết để đánh giá sâu hơn những phát hiện ban đầu này và xác định hướng nghiên cứu cho những năm tiếp theo.

Từ khóa

#ung thư cổ tử cung #hóa trị xạ trị #cisplatin #5-fluorouracil #xếp loại tiên lượng #chụp cắt lớp phát xạ positron #cải thiện kiểm soát

Tài liệu tham khảo

Keys HM, Bundy BN, Stehman FB, et al.: Cisplatin, radiation and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med 1999, 340:1154–1161. One of five seminal chemoradiotherapy trials that set the standard for treatment of locally advanced cervix cancer. Whitney CW, Sause W, Bundy BN, et al.: A randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stages IIB-IVA carcinoma of the cervix with negative para-aortic lymph nodes. A Gynecologic Oncology Group and Southwest Oncology Group Study. J Clin Oncol 1999, 17:1339–1348. The second of five important chemoradiotherapy trials in this disease. Rose PG, Bundy BN, Watkins EB, et al.: Concurrent cisplatinbased chemoradiation in locally advanced cervical cancer. N Engl J Med 1999, 340:1144–1153. The third of five important chemoradiotherapy trials in this disease. Morris M, Eifel PJ, Lu J, et al.: Pelvic radiation with concurrent chemotherapy versus pelvic and para-aortic radiation for high-risk cervical cancer: a randomized Radiation Therapy Oncology Group clinical trial. N Engl J Med 1999, 340:1137–1143. The fourth of five important chemoradiotherapy trials in this disease. Peters WA III, Liu PY, Barrett RJ II, et al.: Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol 2000, 18:1606–1613. The last of five important chemoradiotherapy trials in this disease. Lehman M, Thomas G: Is concurrent chemotherapy and radiotherapy the new standard of care for locally advanced cervical cancer? Int J Gynecol Cancer 2001, 11:87–99. The authors provide a critical review of the reasons for failure of primary radiotherapy in locally advanced cervix cancer and raise a number of issues that should be addressed by future clinical trials. Christensen GE, Carlson B, Chao KS, et al.: Image-based dose planning of intracavitary brachytherapy: registration of serial-imaging studies using deformable anatomic templates. Int J Radiat Oncol Biol Phys 2001, 51:227–243. Quint S, de Boer HC, van Sornsen de Koste JR, et al.: Set-up verification of cervix cancer patients treated with long treatment fields: implications of a non-rigid bony anatomy. Radiother Oncol 2001, 60:25–29. Fellner C, Potter R, Knocke TH, Wambersie A: Comparison of radiography- and computed tomography-based treatment planning in cervix cancer in brachytherapy with specific attention to some quality assurance aspects. Radiother Oncol 2001, 58:53–62. A critical comparison of CT treatment planning with standard radiographic treatment planning. Sood BM, Gorla G, Gupta S, et al.: Two fractions of high-doserate brachytherapy in the management of cervix cancer: clinical experience with and without chemotherapy. Int J Radiat Oncol Biol Phys 2002, 53:702–706. Ferrigno R, dos Santos Novaes PE, Pellizzon AC, et al.: Highdose-rate brachytherapy in the treatment of uterine cervix cancer: analysis of dose effectiveness and late complications. Int J Radiat Oncol Biol Phys 2001, 50:1123–1135. Fyles A, Milosevic M, Hedley D, et al.: Tumor hypoxia has independent predictor impact only in patients with nodenegative cervix cancer. J Clin Oncol 2002, 20:680–687. Milosevic M, Fyles A, Hedley D, et al.: Interstitial fluid pressure predicts survival in patients with cervix cancer independent of clinical prognostic factors and tumor oxygen measurements. Cancer Res 2001, 61:6400–6405. West CML, Cooper RA, Loncaster JA, et al.: Tumor vascularity: a histological measure of angiogenesis and hypoxia. Cancer Res 2001, 61:2907–2910. Grogan M, Thomas GM, Melamed I, et al.: The importance of hemoglobin levels during radiotherapy for carcinoma of the cervix. Cancer 1999, 86:1528–1536. This paper critically reviews the value of hemoglobin level and response to radiotherapy in a retrospective analysis and sets the direction for development of a clinical trial designed to determine whether maintenance of normal hemoglobin level during radiotherapy improves the clinical result. Kapp KS, Poschauko J, Geyer E, et al.: Evaluation of the effect of routine packed red blood cell transfusion in anemic cervix cancer patients treated with radical radiotherapy. Int J Radiat Oncol Biol Phys 2002, 54:58–66. Kavanagh BD, Fischer BA IV, Segreti EM, et al.: Cost analysis of erythropoietin versus blood transfusions for cervical cancer patients receiving chemoradiotherapy. Int J Radiat Oncol Biol Phys 2001, 51:435–441. Dowdy SC, Boardman CH, Wilson TO, et al.: Multimodal therapy including neoadjuvant methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) for stage IIB to IV cervical cancer. Am J Obstet Gynecol 2002, 186:1167–1173. Long HJ III, Rayson S, Podratz KC, et al.: Long-term survival of patients with advanced/recurrent carcinoma of cervix and vagina after neoadjuvant treatment with methotrexate, vinblastine, doxorubicin, and cisplatin with or without the addition of molgramostim, and review of the literature. Am J Clin Oncol 2002, 25:547–551. MacLeod C, O’Donnell A, Tattersall MH, et al.: Locally advanced cervix cancer: chemotherapy prior to definitive surgery or radiotherapy: a single institutional experience. Australas Radiol 2001, 45:491–495. Lantzsch T, Wolters M, Grimm J, et al.: Sentinel node procedure in Ib cervical cancer: a preliminary series. Brit J Cancer 2001, 85:791–794. Maldur S, Krause N, Kohler C, Schneider A: Sentinel lymph node detection in patients with cervical cancer. Gynecol Oncol 2001, 80:254–257. O’Boyle JD, Coleman RL, Bernstein SG, et al.: Intraoperative lymphatic mapping in cervix cancer patients undergoing radical hysterectomy: a pilot study. Gynecol Oncol 2000, 79:238–243. Kerr IG, Manji MF, Powe J, et al.: Positron emission tomography for the evaluation of metastases in patients with carcinoma of the cervix: a retrospective review. Gynecol Oncol 2001, 81:477–480.