复发性宫颈癌的治疗现状及进展

doi:10.12280/gjfckx.20200695

摘要/Abstract

摘要：

宫颈癌是女性生殖系统最常见的恶性肿瘤,尽管宫颈癌筛查不断普及,全球宫颈癌发病率较前下降,仍有约75%的宫颈癌患者在初始治疗后2年内复发。复发性宫颈癌严重影响患者的预后及生存率,但目前对于复发性宫颈癌尚无标准化治疗方案。随着肿瘤免疫疗法的出现、放射治疗方法的应用、化疗方案的不断完善以及手术方式的不断改进,复发性宫颈癌患者的治疗方案不断增加,但治疗过程中较高的并发症发生率仍不可忽视。因此,进一步完善复发性宫颈癌的治疗方法并提高患者的生存率仍是复发性宫颈癌治疗的重点和难点。本文就复发性宫颈癌的治疗现状及进展,从手术治疗、化学治疗、免疫治疗及放射治疗方面作一综述,旨在为复发性宫颈癌患者治疗方案的选择提供思路。

关键词: 宫颈肿瘤, 肿瘤复发,局部, 妇科外科手术, 抗肿瘤联合化疗方案, 免疫疗法, 放射疗法

Abstract:

Cervical cancer is the most common malignant tumor in the female reproductive system. Despite the popularity of cervical cancer screening and the incidence of cervical cancer in the world is lower than before, about 75% of cervical cancer patients still relapse within two years after initial treatment. Recurrent cervical cancer seriously affects the prognosis and survival rate of patients, but there is no standardized treatment for recurrent cervical cancer. With the emergence of tumor immunotherapy, the application of radiotherapy, the continuous improvement of chemotherapy regimen, and the improvement of surgical methods, the treatment scheme of patients with recurrent cervical cancer is increasing, but the high incidence of complications during the treatment can not be ignored. Therefore, further improving the treatment of recurrent cervical cancer and improving the survival rate of patients is still a difficult point in the treatment of recurrent cervical cancer. This article reviews the current situation and progress of the treatment of recurrent cervical cancer, from the aspects of surgical treatments, chemotherapy, immunotherapy, and radiotherapy, aim to provide ideas for the choice of treatment options for patients with recurrent cervical cancer.

Key words: Uterine cervical neoplasms, Neoplasm recurrence,local, Gynecologic surgical procedures, Antineoplastic combined chemotherapy protocols, Immunotherapy, Radiotherapy

巨宇叶, 张芳芳, 王晓慧. 复发性宫颈癌的治疗现状及进展[J]. 国际妇产科学杂志, 2021, 48(1): 56-60.

JU Yu-ye, ZHANG Fang-fang, WANG Xiao-hui. Current Status and Progress of Treatment of Recurrent Cervical Cancer[J]. Journal of International Obstetrics and Gynecology, 2021, 48(1): 56-60.

参考文献 35

[1]	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018,68(6):394-424. doi: 10.3322/caac.21492. doi: 10.3322/caac.21492 pmid: 30207593
[2]	Kasamatsu T, Onda T, Yamada T, et al. Clinical aspects and prognosis of pelvic recurrence of cervical carcinoma[J]. Int J Gynaecol Obstet, 2005,89(1):39-44. doi: 10.1016/j.ijgo.2004.12.020. doi: 10.1016/j.ijgo.2004.12.020 pmid: 15777897
[3]	Howlader N, Noone AM, Krapcho M, et al. SEER Cancer Statistics Review,1975-2017[EB/OL]. Bethesda:National Cancer Institute,2019(2019-11)[2020-04]. https://seer.cancer.gov/csr/1975_2017.
[4]	周晖, 白守民, 林仲秋. 《2019 NCCN宫颈癌临床实践指南(第1版)》解读[J]. 中国实用妇科与产科杂志, 2018,34(9):1002-1009. doi: 10.19538/j.fk2018090114.
[5]	韩瑛, 吴令英, 李宁, 等. 45例复发性宫颈癌患者手术治疗的临床分析[J]. 中华肿瘤杂志, 2017,39(5):369-373. doi: 10.3760/cma.j.issn.0253-3766.2017.05.010.
[6]	Zhu T, Shao Z. Clinicopathological features and prognostic factors for patients with recurrent cervical cancer treated with secondary surgical resection plus radiotherapy[J]. Gynecol Oncol, 2019,154:275.
[7]	白萍, 马莹, 李巍, 等. 子宫颈癌全量放疗后局部肿瘤未控或中心型复发患者的手术治疗[J]. 中华肿瘤杂志, 2010,32(1):52-55. doi: 10.3760/cma.j.issn.0253-3766.2010.01.013.
[8]	Waters PS, Peacock O, Warrier SK, et al. Evolution of pelvic exenteration surgery- resectional trends and survival outcomes over three decades[J]. Eur J Surg Oncol, 2019,45(12):2325-2333. doi: 10.1016/j.ejso.2019.07.015. doi: 10.1016/j.ejso.2019.07.015 pmid: 31303376
[9]	陈圆, 王志启, 邓浩, 等. 复发性子宫颈癌行盆腔廓清术围术期情况及近期预后分析[J]. 实用妇产科杂志, 2019,35(2):141-145.
[10]	张灿, 张国楠. 盆腔廓清术在原发及复发性宫颈癌中应用的系统评价[J]. 现代妇产科进展, 2020,29(2):92-97. doi: 10.13283/j.cnki.xdfckjz.2020.02.003.
[11]	Yang Q, Tang J, Xiao L. Disease-free survival after robotic-assisted laparoscopic total pelvic exenteration for recurrent cervical adenocarcinoma: A case report[J]. Medicine(Baltimore), 2018,97(30):e11611. doi: 10.1097/MD.0000000000011611.
[12]	Bizzarri N, Chiantera V, Ercoli A, et al. Minimally Invasive Pelvic Exenteration for Gynecologic Malignancies: A Multi-Institutional Case Series and Review of the Literature[J]. J Minim Invasive Gynecol, 2019,26(7):1316-1326. doi: 10.1016/j.jmig.2018.12.019. doi: 10.1016/j.jmig.2018.12.019 pmid: 30611973
[13]	Perez CA, Grigsby PW, Camel HM, et al. Irradiation alone or combined with surgery in stage IB, IIA, and IIB carcinoma of uterine cervix: update of a nonrandomized comparison[J]. Int J Radiat Oncol Biol Phys, 1995,31(4):703-716. doi: 10.1016/0360-3016(94)00523-0. doi: 10.1016/0360-3016(94)00523-0 pmid: 7860381
[14]	Schmidt AM, Imesch P, Fink D, et al. Indications and long-term clinical outcomes in 282 patients with pelvic exenteration for advanced or recurrent cervical cancer[J]. Gynecol Oncol, 2012,125(3):604-609. doi: 10.1016/j.ygyno.2012.03.001. doi: 10.1016/j.ygyno.2012.03.001
[15]	Yamamoto K, Yoshikawa H, Shiromizu K, et al. Pulmonary metastasectomy for uterine cervical cancer: a multivariate analysis[J]. Ann Thorac Surg, 2004,77(4):1179-1182. doi: 10.1016/j.athoracsur.2003.06.023. doi: 10.1016/j.athoracsur.2003.06.023
[16]	Monk BJ, Sill MW, McMeekin DS, et al. Phase III trial of four cisplatin-containing doublet combinations in stage IVB, recurrent, or persistent cervical carcinoma: a Gynecologic Oncology Group study[J]. J Clin Oncol, 2009,27(28):4649-4655. doi: 10.1200/JCO.2009.21.8909. doi: 10.1200/JCO.2009.21.8909 pmid: 19720909
[17]	Vasudev NS, Reynolds AR. Anti-angiogenic therapy for cancer: current progress, unresolved questions and future directions[J]. Angiogenesis, 2014,17(3):471-494. doi: 10.1007/s10456-014-9420-y. doi: 10.1007/s10456-014-9420-y
[18]	Suzuki K, Nagao S, Shibutani T, et al. Phase II trial of paclitaxel,carboplatin,and bevacizumab for advanced or recurrent cervical cancer[J]. Gynecol Oncol, 2019,154(3):554-557. doi: 10.1016/j.ygyno.2019.05.018. doi: 10.1016/j.ygyno.2019.05.018 pmid: 31285082
[19]	程蕾, 陈周红. 紫杉醇在治疗晚期或复发性宫颈癌中的应用分析[J]. 基因组学与应用生物学, 2020,39(1):337-342. doi: 10.13417/j.gab.039.000337.
[20]	Downs LS Jr, Chura JC, Argenta PA, et al. Ifosfamide, paclitaxel, and carboplatin, a novel triplet regimen for advanced, recurrent, or persistent carcinoma of the cervix: a phase II trial[J]. Gynecol Oncol, 2011,120(2):265-269. doi: 10.1016/j.ygyno.2010.10.020. doi: 10.1016/j.ygyno.2010.10.020
[21]	Choi HJ, Lee YY, Choi CH, et al. Triplet chemotherapy vs doublet chemotherapy plus bevacizumab in metastatic,recurrent,and persistent cervical cancer[J]. Curr Probl Cancer, 2020,44(5):100557. doi: 10.1016/j.currproblcancer.2020.100557. doi: 10.1016/j.currproblcancer.2020.100557 pmid: 32067746
[22]	鲁亮, 刘爱华, 张汉群, 等. 培美曲塞联合长春瑞滨治疗一线化疗失败的复发转移性宫颈癌的疗效研究[J]. 中国全科医学, 2019,22(30):3679-3682. doi: 10.12114/j.issn.1007-9572.2019.00.393.
[23]	鲁亮, 刘爱华, 张汉群, 等. 贝伐珠单抗联合长春瑞滨二线治疗复发转移性宫颈癌患者的近期疗效[J]. 现代肿瘤医学, 2020,28(3):451-454. doi: 10.3969/j.issn.1672-4992.2020.03.022.
[24]	Xiao Y, Cheng H, Yu X, et al. Clinical response and safety of apatinib monotherapy in recurrent or metastatic cervical cancer after failure of chemotherapy: An observational study[J]. Gynecol Oncol, 2019,154:232.
[25]	Wu X, Gu Z, Chen Y, et al. Application of PD-1 Blockade in Cancer Immunotherapy[J]. Comput Struct Biotechnol J, 2019,17:661-674. doi: 10.1016/j.csbj.2019.03.006. doi: 10.1016/j.csbj.2019.03.006 pmid: 31205619
[26]	Pan K, Gong J, Huynh K, et al. Current Systemic Treatment Landscape of Advanced Gynecologic Malignancies[J]. Target Oncol, 2019,14(3):269-283. doi: 10.1007/s11523-019-00641-9. doi: 10.1007/s11523-019-00641-9 pmid: 31069647
[27]	Rischin D, Gil-Martin M, Gonzalez-Martin A, et al. 958P Cemiplimab, a human PD-1 monoclonal antibody, in patients (pts) with recurrent or metastatic cervical cancer: Interim data from phase I cohorts[J]. Ann Oncol, 2018,29(Suppl 8). doi: 10.1093/annonc/mdy285.166.
[28]	Naumann RW, Oaknin A, Meyer T, et al. LBA62 - Efficacy and safety of nivolumab (Nivo) + ipilimumab (Ipi) in patients (pts) with recurrent/metastatic (R/M) cervical cancer: Results from CheckMate 358[J]. Ann Oncol, 2019,30(Suppl 5):v898-v899. doi: 10.1093/annonc/mdz394.059
[29]	Otter SJ, Chatterjee J, Stewart AJ, et al. The Role of Biomarkers for the Prediction of Response to Checkpoint Immunotherapy and the Rationale for the Use of Checkpoint Immunotherapy in Cervical Cancer[J]. Clin Oncol(R Coll Radiol), 2019,31(12):834-843. doi: 10.1016/j.clon.2019.07.003.
[30]	Jazaeri AA, Edwards RP, Zsiros E, et al. A phase II,multicenter study to evaluate the efficacy and safety using autologous tumor infiltrating lymphocytes (LN-145) in patients with recurrent,metastatic,or persistent cervical carcinoma[J]. J Clinical Oncol, 2018,149:118. doi: 10.1200/JCO.2018.36.15_suppl.TPS5604.
[31]	Kozai Y, Itoh Y, Kawamura M, et al. High-dose-rate intracavitary brachytherapy for recurrent cervical cancer in the vaginal stump after hysterectomy[J]. Nagoya J Med Sci, 2019,81(3):351-358. doi: 10.18999/nagjms.81.3.351. doi: 10.18999/nagjms.81.3.351 pmid: 31579327
[32]	Brogna A, Midili F, Siragusa C, et al. A.19-Stereotactic radiotherapy in the retreatment of recurrent cervical cancers[J]. Physica Medica, 2016,32(Suppl 1):6. doi: org/10.1016/j.ejmp.2016.01.023.
[33]	蒋佳佳, 刘红, 王玉净, 等. 宫颈癌术后盆腔复发患者放射治疗效果及预后的影响因素[J]. 中华放射医学与防护杂志, 2019,39(3):208-212. doi: 10.3760/cma.j.issn.0254-5098.2019.03.009.
[34]	Kobayashi K, Murakami N, Takahashi K, et al. Local Radiotherapy or Chemotherapy for Oligo-recurrent Cervical Cancer in Patients With Prior Pelvic Irradiation[J]. In Vivo, 2019,33(5):1659-1665. doi: 10.21873/invivo.11652. doi: 10.21873/invivo.11652 pmid: 31471420
[35]	Kim HJ, Chang JS, Koom WS, et al. Radiotherapy is a safe and effective salvage treatment for recurrent cervical cancer[J]. Gynecol Oncol, 2018,151(2):208-214. doi: 10.1016/j.ygyno.2018.08.029. doi: 10.1016/j.ygyno.2018.08.029 pmid: 30195468