Serviks kanserinde radyoterapi tedavisinin yeri ve önemi

Serviks kanseri jinekolojik kanserler içinde sıklık açısından ikinci sırada yer almaktadır. Radyoterapi, yaklaşık yüzyıllık süreçte serviks kanseri tedavisinde kullanılmaktadır. Özellikle de lokal ileri hastalıkta ilk tedavi seçeneği olmuştur. Tek başına eksternal radyoterapi büyük tümörlerde düşük kontrol oranı sağlamaktadır. Serviks kanserinde brakiterapinin de kullanılması ile büyük tümörlerin kontrol oranları yükselmiştir. Son yıllarda radyoterapinin etkinliğini arttırmak amacıyla kemoradyoterapinin birlikte kullanımı gündeme gelmiştir. Kemoradyoterapi çalışmalarında en sık sisplatin, 5-FU, mitomisin-C ve hidroksiüre kullanılmıştır. Bu çalışmaların sonucunda kemoradyoterapinin uygulandığı randomize çalışmalarda görülmüştür ki serviks kanserinde kemoradyoterapi uygulanmasının, özellikle de sisplatinin sağkalım avantajı sağladığı gösterilmiştir

Cervical cancer ranks second in terms of frequency of gynecological cancers. Radiation therapy used to treat cervical cancer in the process nearly a century. In particular, became first-line treatment in locally advanced disease. Provides a low control rate in large tumors with external beam radiotherapy alone. Large tumors with the use of brachytherapy in cervical cancer control rates were also increased. The most common work chemoradiotherapy cisplatin, 5-FU and mitomycin-C, hydroxyurea, is used. Suffered as a result of these studies, randomized trials that applied chemoradiotherapy implementation of chemoradiation in cervical cancer, especially cisplatin shown to provide a survival advantagein recent years, in order to increase the effectiveness of radiotherapy with chemoradiotherapy was introduced

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  • Akine Y, Arimoto H, Ogino T, ve ark.1983. High dose rate intracavitary irradiation in the treatment of carcinoma of the uterine cervix:whole pelvis ırradiation and ıntracavitary radium. Int. J. Radiat Oncol Biol Phys. 9:367-71.
  • Badib AO, Kurohara SS, Werteb JH, Pickren JW.1968. Metastasis to organs ın carcinoma of the uterine cervix:influence of treatment on incidebce and distribution. Cancer. 21:434
  • Carlson V, Delclos L, Fletcher GH. 1967.Distant metastases in squamous-cell carcinoma of the uterine cervix. Radiology 88:961
  • Chauvergne J, Rohart J, Heron JF, ve ark.1990.Randomised trial of initial chemotherapy in 151 locally advanced carcinoma of the cervix (T2b-N1, T3b, M0). Bull Cancer. 77:1007-24.
  • Dietmar Georg, Petra Georg, Martin Hillbrand, ve ark.2008. Assessment of ımproved organ at risk sparing for advanced cervix utilizing precision radiotherapy techniques. Strahlender Onkol.184:586
  • Eifel PJ, Winter K, Morris M, ve ark.2004. Pelvic irradiation with concurrent chemotherapy versus pelvic and para-aortic irradiation for high risk cervical cancer:an update of radiation therapy oncology group trial (Rtog) 90-01. J Clin Oncol .22:972-980.
  • Grisby PW, Siegel Ba, Dehdashti F. 2001. Lymph node staging by positron emission tomography in patients with carcinoma of the cervix. J Clin Gynecol. 19:3745-3749.
  • Hamberger AD, Fletcher GH, Wharton JT.1978. Results of treatment of early stage I carcinoma of the uterine cervix with intracavitary radium alone. Cancer. 41(3):980-985.
  • Heller PB, Malfenato JH, Bundy BN ve ark. 1990. Clinical-pathologic study of stage IIB, III and IVA carcinoma of the cervix: extended diagnostic evaluation for para-aortic node metastasis. Gynecol Onco.; 38:425-430.
  • Horiot JC, Pigneux J, Pourquer H, Scaraub S, Achielle E, Keilling R, Combes P, Rozan R, Vrousos C, Daly N.1988. Radiotherapy alone in carcinoma of the intact uterine cervix according to G.H Fletcher guidelines: a french cooperative study off 1383 cases . Int J. Radit Oncol Biol Phys;14:605-611.
  • Inoue T.1984. Prognostic significance of depth of invasion relating to nodal metastases, parametrial extension and cell types. a study of 628 cases with stage IB, IIA and IIB cervical carcinoma. Cancer : 3035
  • International Federation of Gynecology and Obstetrics.1995: Staging announcement figo staging of gynecologyic cancers: cervical and vulva. Int J Gynecol Cancer ; 5:319-324.
  • Keys HM, Bundy BN, Frederick BS ve ark. 1999.Cisplatin, radiation and adjuvant histerectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. New Engl J Med. 340: 1154-1164.
  • Lehman M, Thomas G 2001. Is concurrent chemotherapy the new standard of care for advanced cervical cancer. Int J Gynecol Cancer 11: 87-99
  • Morris M, Elfel PJ, J Lu ve ark. 1999. Pelvic radiation with concurrent chemoradiotherapy compared pelvic and para-aortic radiation for high risk cervical cancer. New England Journal Of Medicine 340: 1143.
  • National Institues Of Health Concensus Development Conference Statement On Cervical Cancer1997. Gynecol Oncol; 66:351-361.
  • Perez CA, Camel HM, Aksin F, Breaux S 1981. Endometrial extension of carcinoma of the uterine cervix:a prognostic factor that may modify staging. Cancer. 48:170
  • Peters WA, Liu PY, Barret RJ ve ark. 2000. Concurrent chemotherapy and pelvic radiation therapy alone as adjuvant after radical surgery in high-risk early stage cancer of risk. Journal Of Clinical Oncology;18:1606-1613.
  • Pignon JP, Bourhis J, Domenge C, Designe L on Behalf of The Mach-Nc Collaboratıve Group. Chemotherapy added to locoregional treatment for head and neck squamous cell carcinoma: three meta-analyses of updated individual data. Lancet. 355: 949-945. Robert KB, Urdaneta N, Vera R ve ark.2000. Interim results of a randomized trial of mitomycin-c as an adjunct to radical radiotherapy in the treatment of locally advanced squamoz cell carcinoma of the cerviks. Int J Cancer , 90:206-223
  • Rose PG, Bundy BN, Watkıns EB ve ark.1999. Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. New Engl Med 340: 1144-1153.
  • Rose PG.1994. Locally advanced cervical carcinoma the role of chemoradiation. Semin Oncol. 21: 47
  • Russel AH, Walter JP, Anderson NW ve ark.1992. Sagittal magnetic resonance imaging in the design of lateral radiation treatment portals for patients with locally advanced squamous cancer of the cervix.
  • Int J Radiat Oncol Biol Phys 23:449-455. Spensley S ve ark. 2008. Clinical outcome for chemotadiotherapy in carcinoma of the cervix. Clinical Onco.
  • Sundfer K, Trope CG, Hogberg T ve ark.1996. Radiotherapy and neoadjuvant chemotherapy for cervical carcinoma. a randomized multicenter study of sequential cisplatin and 5-flourouracil and radiotherapy in advanced cervical carcinoma stage 3B and 4A. Cancer.77: 2371-2378.
  • Tanaka Y, Sawada S, Murata T.1984: Relationship between lymph node metastases and prognosis in patients irradiated postoperatively for carcinoma of the uterine cervix. Acta Radiol. 23: 455
  • Wharton JT, Jones HW III, Day TG JR ve ark.1977. Preirrdadiation celiotomy and extended field ırradiation for ınvasive carcinoma of the cervix. Obstet Gynecol. 49:333
  • Whitney CW, Sause W, Bundy BN ve ark.1999. A randomized comparison of fluorourasil 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.17:1339-1342.
  • Whitney CW, Sause W, Bunndy BN ve ark. 1999. Randomized comparison of flurouracil plus cisplatin versus as an adjunct to radiation therapy in stage IIIVA carcinoma of the cervix with negative paraortic lymph nodes. A gynecologic oncology group and south oncology group study. J Clin Oncol. :1339-1348.
  • Wong LC, Ngan HYS, Cheung ANY ve ark.1999. Chemoradiation and adjuvant chemotherapy in cervical cancer. Journal of Clinical Oncology.17: 2055-2060.