宫颈癌标准治疗选择课件.ppt

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1、Standard Treatment Optionsfor Cervical Cancer,FIGO: Staging classifications and clinical practice guidelines of Cervical cancerNational Cancer Institute M.D. Anderson Cancer CenterPractical Gynecologic Oncology 4th Edition,宫颈癌标准治疗选择,Standard Treatment Optionsfor,Cancers of the Female Reproductive Tr

2、act:Worldwide Statistics1,Ferlay et al. GLOBOCAN 2000 IARC, WHO 2001 (),宫颈癌标准治疗选择,Cancers of the Female Reproduc,1974-2000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,宫颈癌标准治疗选择,1974-2000上海市居民妇科肿瘤发病率上海市肿瘤研究流,宫颈癌标准治疗选择,宫颈癌标准治疗选择,宫颈癌标准治疗选择,宫颈癌标准治疗选择,Treatment Option Overview,Five randomized phase III trials have shown

3、 an overall survival advantage for cisplatin-based therapy given concurrently with radiation therapy,1-6 while 1 trial examining this regimen demonstrated no benefit.7The risk of death from cervical cancer was decreased by 30% to 50% by concurrent chemoradiation. Based on these results, strong consi

4、deration should be given to the incorporation of concurrent cisplatin- based chemotherapy with radiation therapy in women who require radiation therapy for treatment of cervical cancer.1-8,宫颈癌标准治疗选择,Treatment Option Overview Five,Treatment Option Overview,Surgery and radiation therapy are equally ef

5、fective for early-stage small-volume disease.9 Younger patients may benefit from surgery in regard to ovarian preservation and avoidance of vaginal atrophy and stenosis. Patterns of care studies clearly demonstrate the negative prognostic effect of increasing tumor volume. Therefore, treatment may v

6、ary within each stage as currently defined by FIGO, and will depend on tumor bulk and spread pattern.10,宫颈癌标准治疗选择,Treatment Option OverviewSurge,Treatment Option Overview,Therapy of patients with cancer of the cervical stump is effective, yielding results comparable to those seen in patients with an

7、 intact uterus.11 During pregnancy, no therapy is warranted for preinvasive lesions of the cervix, including carcinoma in situ, although expert colposcopy is recommended to exclude invasive cancer. Treatment of invasive cervical cancer during pregnancy depends on the stage of the cancer and gestatio

8、nal age at diagnosis.,宫颈癌标准治疗选择,Treatment Option OverviewThera,宫颈癌分期:临床诊断分期,有经验的医师、在麻醉下进行检查后来的发现不能改变已经确定的期别触诊、视诊、阴道镜、宫颈管诊刮术(ECC)、宫腔镜、膀胱镜、直肠镜、静脉尿路造影、以及骨骼和肺部x线检查膀胱和直肠怀疑病灶须经活检并有组织学证实淋巴管造影、动脉造影、静脉造影、剖腹探查术、超声探查、CT扫描和磁共振（MRI）等，故不能作为改变期别的根据对扫描检查怀疑的淋巴结行细针穿刺，能帮助制定治疗计划,宫颈癌标准治疗选择,宫颈癌分期:临床诊断分期有经验的医师、在麻醉下进行检查宫颈,

9、宫颈癌分期:手术治疗后病理分期,手术-病理检查切除的标本结果，是最确切诊断肿瘤侵犯范围这些结果不能改变临床分期，但可将这些结果记录在疾病的病理分期法则中，TNM分期正是符合情况首次诊断时确定分期，而且不能更改，即使在复发时也是如此只有在临床分期的准则严格执行时，才有可能比较各个临床单位和不同治疗方式的结果,宫颈癌标准治疗选择,宫颈癌分期:手术治疗后病理分期手术-病理检查切除的标本结,宫颈癌标准治疗选择,宫颈癌标准治疗选择,临床分期检查方法,临床分期非损伤性诊断检查双足淋巴管X线照片（Bipedal lymphangiogram） 计算机断层X线扫描术（CT, Computed Tomograp

10、hy） 超声波扫描术（Ultrasonography） 磁共振成像（MRI, Magnetic Resonance Imaging） 正电子发射断层扫描（PET, Positron Emission Tomography） 细针吸取细胞学检查 手术分期： 治疗前，腹主动脉旁LN，延伸放射野?剖腹探查术的方法腹腔镜分期,宫颈癌标准治疗选择,临床分期检查方法临床分期宫颈癌标准治疗选择,Surgical Staging,Pretreatment surgical staging is the most accurate method to determine extent of disease. B

11、ecause there is little evidence to demonstrate overall improved survival with routine surgical staging, it usually should be performed only as part of a clinical trial. Pretreatment surgical staging in bulky, but locally curable, disease may be indicated in select cases when a nonsurgical search for

12、 metastatic disease is negative. If abnormal nodes are detected by CT scan or lymphangiography, fine needle aspiration should be negative before a surgical staging procedure is performed.,宫颈癌标准治疗选择,Surgical StagingPretreatment s,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 J Clin Oncol 2001;19: 37453749.),宫颈癌标准治

13、疗选择,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,IB期宫颈癌盆腔淋巴结转移率,宫颈癌标准治疗选择,IB期宫颈癌盆腔淋巴结转移率 宫颈癌标准治疗选择,II 和 III期宫颈癌腹主动脉旁淋巴结转移率,宫颈癌标准治疗选择,II 和 III期宫颈癌腹主动脉旁淋巴结转移率 宫颈癌标准,宫颈癌治疗：根据期别选择,0期微小浸润癌B1期和早A癌B至A期宫颈癌,宫颈癌标准治疗选择,宫颈癌治疗：根据期别选择0期宫颈癌标准治疗选择,Stage 0 Cervical Cancer,Standard treatment options: Methods to treat ectocervical

14、lesions include: Loop electrosurgical excision procedure (LEEP).7,8 Laser therapy.9 Conization. Cryotherapy.10 When the endocervical canal is involved, laser or cold-knife conization may be used for selected patients to preserve the uterus and avoid radiation therapy and/or more extensive surgery. T

15、otal abdominal or vaginal hysterectomy is an accepted therapy for the postreproductive age group and is particularly indicated when the neoplastic process extends to the inner cone margin.For medically inoperable patients, a single intracavitary insertion with tandem and ovoids for 5,000 milligram h

16、ours (8,000 cGy vaginal surface dose) may be used.11,宫颈癌标准治疗选择,Stage 0 Cervical Cancer Standa,对异常Pap 涂片或活检示微小浸润癌处理步骤,宫颈癌标准治疗选择,对异常Pap 涂片或活检示微小浸润癌处理步骤 Pap涂片异常,Stage IA Cervical Cancer Equivalent treatment options:,Intracavitary radiation alone: If the depth of invasion is less than 3 millimeters and

17、no capillary lymphatic space invasion is noted, the frequency of lymph node involvement is sufficiently low that external beam radiation is not required. One or 2 insertions with tandem and ovoids for 6,500 to 8,000 milligram hours (10,000-12,500 cGy vaginal surface dose) are recommended.4 Radiation

18、 should be reserved for women who are not surgical candidates.,宫颈癌标准治疗选择,Stage IA Cervical Cancer Equi,IB 和早 IIA期宫颈癌的治疗步骤,宫颈癌标准治疗选择,IB 和早 IIA期宫颈癌的治疗步骤期根治性子宫切除淋巴结,Stage IIB Cervical Cancer Stage III Cervical Cancer Stage IVA Cervical Cancer,Radiation therapy plus chemotherapy: Intracavitary radiation

19、 and external-beam pelvic irradiation combined with cisplatin or cisplatin/fluorouracil.7-12,宫颈癌标准治疗选择,Stage IIB Cervical Cancer St,晚期宫颈癌的诊治步骤,宫颈癌标准治疗选择,晚期宫颈癌的诊治步骤B-A宫颈癌腹、盆腔CT盆、腹腔阴性,Recurrent Cervical Cancer,Standard treatment options: For recurrence in the pelvis following radical surgery, radiatio

20、n in combination with chemotherapy (fluorouracil with or without mitomycin) may cure 40% to 50% of patients.3 Chemotherapy can be used for palliation. Tested drugs include: Cisplatin (15%-25% response rate).4 Ifosfamide (15%-30% response rate).5,6 Ifosfamide-cisplatin.7,8 Paclitaxel (17% response ra

21、te).9 Irinotecan (21% response rate in patients previously treated with chemotherapy).10 Paclitaxel/cisplatin (46% response rate).11 Cisplatin/gemcitabine (41% response rate).12,宫颈癌标准治疗选择,Recurrent Cervical Cancer Sta,术后放射治疗：范围及适应症,标准野 ：阳性盆腔淋巴结阳性宫旁组织阳性手术切缘阳性患者小野：淋巴结阴性+高危因素临床肿瘤大小淋巴管腔侵犯肿瘤浸润深度,宫颈癌标准治疗选择,术后放射治疗：范围及适应症 标准野 ：宫颈癌标准治疗选择,宫颈癌根治子宫和双侧盆腔淋巴结切除后无病生存率,宫颈癌标准治疗选择,宫颈癌根治子宫和双侧盆腔淋巴结切除后无病生存率 宫颈癌标准治,盆腔放射的标准野和小野之间的比较,宫颈癌标准治疗选择,盆腔放射的标准野和小野之间的比较 宫颈癌标准治疗选择,宫颈癌标准治疗选择,宫颈癌标准治疗选择,宫颈癌标准治疗选择,宫颈癌标准治疗选择,宫颈癌标准治疗选择,宫颈癌标准治疗选择,宫颈癌标准治疗选择,宫颈癌标准治疗选择,宫颈癌标准治疗选择,宫颈癌标准治疗选择,宫颈癌标准治疗选择,宫颈癌标准治疗选择,谢 谢,宫颈癌标准治疗选择,谢 谢宫颈癌标准治疗选择,