国际妇产科学杂志 ›› 2014, Vol. 41 ›› Issue (3): 247-251.

• 综述 • 上一篇    下一篇

宫颈腺癌治疗进展

闻强,方素华   

  1. 310022 杭州,浙江省肿瘤医院妇瘤科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2014-06-15 发布日期:2014-06-15

Treatment Progress of Cervical Adenocarcinoma

WEN Qiang,FANG Su-hua   

  1. Department of Gynecological Oncology,Zhejiang Cancer Hospital,Hangzhou 310022,China
  • Received:1900-01-01 Revised:1900-01-01 Published:2014-06-15 Online:2014-06-15

摘要: 目前对于宫颈腺癌的最佳治疗方案尚无定论。宫颈原位腺癌可采用全子宫切除、宫颈锥形切除或宫颈环形电切术(LEEP)。对ⅠA1期宫颈腺癌以往多采用广泛性子宫切除,现主张采用全子宫切除术,需保留生育功能的患者也可考虑宫颈锥形切除术。对ⅠA2~ⅡA期宫颈腺癌首选广泛性子宫切除+盆腔淋巴结清扫,有高危因素的患者需接受辅助性放化疗。对ⅡB~ⅣA期宫颈腺癌首选根治性放疗联合顺铂周疗的同步放化疗,紫杉醇联合顺铂可用于放疗前后的新辅助化疗及巩固化疗。ⅣB期宫颈腺癌宜采用个体化治疗,紫杉醇联合卡铂或吉西他滨联合顺铂均可使用。局部晚期或巨块型宫颈腺癌无论手术或放疗难度均大,新辅助化疗可以缩小肿瘤以利于手术或放疗,但能否改善生存尚有争议。对于难治性或复发性宫颈腺癌,可采用盆腔脏器廓清术、全盆腔放疗或铂类为基础的姑息性化疗。

关键词: 宫颈肿瘤, 妇科外科手术, 放射疗法, 药物疗法

Abstract: The optimal treatment pattern for cervical adenocarcinoma is still undefined. Patients with ceruical adenocarcinoma in situ often need a simple hysterectomy. But to young patients,fertility-sparing surgeries such as cervical conization and LEEP are also options. To stageⅠA1 cervical adenocarcinoma,simple hysterectomy is much more used than radical hysterectomy now,but to young patients,cervical conization is also appropriate. The choice of treatment for most women with stage ⅠA2 to ⅡA disease is radical hysterectomy plus lymphedenectomy. Some patients require platinum based chemoradiation after surgery because of high-risk surgical-pathologic features. Primary radiation with weekly Cisplatin may be the best option for patients with stage ⅡB to ⅣA cervical adenocarcinoma. Furthermore,Paclitaxel with Cisplatin can be used as neo-adjuvant chemotherapy before radiation or as consolidation chemotherapy following radiation. To choose a treatment for ⅣB diseases is always difficult. Sometimes a palliative chemotherapy such as Paclitaxel plus Carboplatin or Gemcitabine plus Cisplatin is needed. Patients with local advanced or bulky diseases are difficult to deal with. Neo-adjuvant chemotherapy can be used to shrink the tumor. But whether it can prolong survival is still controversial. Management of relapsed or persistent diseases should be individualized,depending on the location of disease and the type of previous therapy. The treatment options including total pelvic exenteration,pelvic radiation and platinum based chemotherapy.

Key words: Uterine cervical neoplasms, Gynecologic surgical procedures, Radiotherapy, Drug therapy