臨床婦人科産科62巻4号

2008年04月発行

今月の臨床 産婦人科臨床の難題を解く─私はこうしている III 婦人科癌治療 【子宮頸癌】

4.子宮頸癌における術後放射線照射のエビデンスは？

著者： 浅川勇雄¹ 長谷川正俊¹

所属機関： ¹奈良県立医科大学放射線腫瘍医学講座

ページ範囲：P.566 - P.571

1 はじめに

　わが国では一般的に，FIGOII期以下の切除可能な子宮頸癌に対しては手術療法が主として行われている^1）．術後照射は骨盤内再発の予防ならびに治療成績の向上を目的として，予後不良因子を有する症例に対して行われてきた．そのため，遡及的な報告が多く，前向きな臨床試験は少ない．したがって，術後照射の有用性については明確なエビデンスは今のところないというのが現状である^2）．

参考文献

1） 日本婦人科腫瘍学会（編） : 子宮頸癌治療ガイドライン 2007年版．pp32─33，金原出版，2007

2） 日本婦人科腫瘍学会（編） : 子宮頸癌治療ガイドライン 2007年版．pp46─50，金原出版，2007

3） NCCN Clinical Practice Guidelines in OncologyTM─Cervical Cancer─V. 1. 2007, National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/PDF/cervical.pdf

） : Health Professional Version. National Cancer Institute http://www.cancer.gov/cancertopics/pdq/treatment/cervical/healthprofessional/

5） Delgado G, Bundy B, Zaino R, et al : Prospective surgical─pathological study of disease─free interval in patients with stage IB squamous cell carcinoma of the cervix : a Gynecologic Oncology Group study. Gynecol Oncol 38 : 352─357, 1990

6） Lin HH, Cheng WF, Chan KW, et al : Risk factors for recurrence in patients with stageIB,IIA, and IIB cervical carcinoma after radical hysterectomy and postoperative pelvic irradiation. Obstet Gynecol 88 : 274─279, 1996

7） Sevin BU, Lu Y, Bloch DA, Nadji M, et al : Surgically defined prognostic parameters in patients with early cervical carcinoma. A multivariate survival tree analysis. Cancer 78 : 1438─1446, 1996

8） Lai CH, Hong JH, Hsueh S, et al : Preoperative prognostic variables and the impact of postoperative adjuvant therapy on the outcomes of Stage IB orIIcervical carcinoma patients with or without pelvic lymph node metastases : an analysis of 891 cases. Cancer 85 : 1537─1546, 1999

9） Sedlis A, Bundy BN, Rotman MZ, et al : A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy : a Gynecologic Oncology Group Study. Gynecol Oncol 73 : 177─183, 1999

10） Yeh SA, Leung SW, Wang CJ, et al : Postoperative radiotherapy in early stage carcinoma of the uterine cervix : Treatment results and prognostic factors. Gynecol Oncol 72 : 10─15, 1999

11） Aoki Y, Sasaki M, Watanabe M, et al : High─risk group in node─positive patients with StageIB,IIA, andIIB cervical carcinoma after radical hysterectomy and postoperative pelvic irradiation. Gynecol Oncol 77 : 305─309, 2000

12） Kodaira T, Fuwa N, Nakanishi T, et al : Retrospective analysis of postoperative radiotherapy for node─negative cervical carcinoma with stageIB─IIB disease. Jpn J Clin Oncol 32 : 255─261, 2002

13） Niibe Y, Karasawa K, Kaizu T, et al : Difference in prognostic factors between StageIB andIIuterine cervical carcinoma patients treated with radical hysterectomy and postoperative radiation therapy. Radiat Med 20 : 161─167, 2002

14） Grisaru DA, Covens A, Franssen E, et al : Histopathologic score predicts recurrence free survival after radical surgery in patients with stageIA2─IB1─2 cervical carcinoma. Cancer 97 : 1904─1908, 2003

15） Grigsby PW : Postoperative irradiation in cervical cancer : prognostic factors and outcome. Radiat Med 22 : 106─110, 2004

16） Shimada M, Kigawa J, Takahashi M, et al : Stromal invasion of the cervix can be excluded from the criteria for using adjuvant radiotherapy following radical surgery for patients with cervical cancer. Gynecol Oncol 93 : 628─631, 2004

17） Shinohara S, Ochi T, Miyazaki T, et al : Histopathological prognostic factors in patients with cervical cancer treated with radical hysterectomy and postoperative radiotherapy. Int J Clin Oncol 9 : 503─509, 2004

18） Uno T, Ito H, Isobe K, et al : Postoperative pelvic radiotherapy for cervical cancer patients with positive parametrial invasion. Gynecol Oncol 96 : 335─340, 2005

19） Kim JH, Kim HJ, Hong S, et al : Post─hysterectomy radiotherapy in FIGO stageIB─IIB uterine cervical carcinoma. Gynecol Oncol 96 : 407─414, 2005

20） Piura B, Rabinovich A, Friger M : Surgical pathologic factors in patients with early─stage cervical carcinoma treated with radical hysterectomy and pelvic lymph node dissection : association with administration of adjuvant radiotherapy and effect on survival. Eur J Gynaecol Oncol 27 : 573─578, 2006

21） Atahan IL, Yildiz F, Ozyar E, et al : Radiotherapy in the adjuvant setting of cervical carcinoma : treatment, results, and prognostic factors. Int J Gynecol Cancer 17 : 813─820, 2007

22） Aoki Y, Watanabe M, Sasaki M, et al : Prognostic factors and failure pattern in lymph node─negative stageIB andIIcervical carcinoma treated with radical hysterectomy and postoperative irradiation. Gynecol Obstet Invest 52 : 13─17, 2001

23） Hong JH, Tsai CS, Lai CH, et al : Postoperative low─pelvic irradiation for stageI─IIA cervical cancer patients with risk factors other than pelvic lymph node metastasis. Int J Radiat Oncol Biol Phys 53 : 1284─1290, 2002

24） Uno T, Ito H, Yasuda S, et al : Adjuvant pelvic irradiation in patients with node─negative carcinoma of the uterine cervix. Anticancer Res 22 : 1213─1216, 2002

25） Rotman M, Sedlis A, Piedmonte MR, et al : A phaseIIIrandomized trial of postoperative pelvic irradiation in stageIB cervical carcinoma with poor prognostic features : Follow─up of a gynecologic oncology group study. Int J Radiat Oncol Biol Phys 65 : 169─176, 2006

26） Frigerio L, Busci L, Rabaiotti E, et al : Adjunctive radiotherapy after radical hysterectomy in high risk earlystage cervical carcinoma. Assessment of morbidity and recurrences. Eur J Gynaecol Oncol 15 : 132─137, 1994

27） Tsai CS, Lai CH, Wang CC, et al : The prognostic factors for patients with early cervical cancer treated by radical hysterectomy and postoperative radiotherapy. Gynecol Oncol 75 : 328─333, 1999

28） Landoni F, Maneo A, Colombo A, et al : Randomised study of radical surgery versus radiotherapy for stageIb─IIa cervical carcinoma. Lancet 350 : 535─540, 1997

29） Chen SW, Liang JA, Yang SN, et al : Postoperative radiotherapy for patients with invasive cervical cancer following treatment with simple hysterectomy. Jpn J Clin Oncol 33 : 477─481, 2003

30） Thomas GT, Dembo AJ : Is there a role for adjuvant pelvic radiotherapy after radical hysterectomy in early stage cervical cancer? Int J Gynecol Cancer 1 : 1─8, 1991

31） Iwasaka T, Kamura T, Yokoyama M, et al : Adjuvant chemotherapy after radical hysterectomy for cervical carcinoma : A comparison with effects of adjuvant radiotherapy. Obstet Gynecol 91 : 977─981, 1998

32） Peters WA 3rd, Liu PY, Barrett RJ 2nd, 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 18 : 1606─1613, 2000

33） Monk BJ, Wang J, Im S, et al : Rethinking the use of radiation and chemotherapy after radical hysterectomy : a clinical─pathologic analysis of a Gynecologic Oncology Group/Southwest Oncology Group/Radiation Therapy Oncology Group trial. Gynecol Oncol 96 : 721─728, 2005

34） Haie C, Pejovic MH, Gerbaulet A, et al : Is prophylactic para─aortic irradiation worthwhile in the treatment of cervical carcinoma? Results of a controlled clinical trial of the EORTC radiotherapy group. Radiother Oncol 11 : 101─112, 1988

35） Rotman M, Choi K, Guze C, et al : Prophylactic irradiation of the para─aortic lymph node chain in stageIIB and bulky stageIB carcinoma of the cervix, initial treatment results of RTOG 7920. Int J Radiat Oncol Biol Phys 19 : 513─521, 1990

36） 熊野町子，有田繁広，石田　修，他 : 子宮頸癌術後における予防的傍大動脈リンパ節照射の意義─リンパ節転移と予後との関係．日放腫会誌7 : 341─349，1995

37） 茶谷正史，又吉嘉伸，真崎規江，他 : 子宮頸癌の傍大動脈リンパ節予防照射に関するprospective randomized trial．臨床放射線41 : 537─541，1996

38） Emami B, Lyman J, Brown A, et al : Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 15 : 109─122, 1991

39） Yamazaki A, Shirato H, Nishioka T, et al : Reduction of late complications after irregularly shaped four─field whole pelvic radiotherapy using computed tomographic simulation compared with parallel─opposed whole pelvic radiotherapy. Jpn J Clin Oncol 30 : 180─184, 2000

40） Uno T, Isobe K, Yamamoto S, et al : Postoperative radiation therapy for carcinoma of the uterine cervix. Radiat Med 24 : 91─97, 2006

41） Mundt AJ, Mell LK, Roeske JC : Preliminary analysis of chronic gastrointestinal toxicity in gynecology patients treated with intensity─modulated whole pelvic radiation therapy. Int J Radiat Oncol Biol Phys 56 : 1354─1360, 2003

42） Jhingran A : Potential advantages of intensity─modulated radiation therapy in gynecologic malignancies. Semin Radiat Oncol 16 : 144─51, 2006

43） 篠田充功，戸板孝文，古平　毅，他 : PCSによる子宮頸癌術後放射線治療の現状─95─97 PCS, 99─01 PCSの比較からの検討．癌の臨床51 : 1045─1049，2005