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20xx年醫(yī)學(xué)專題—宮頸癌診療規(guī)范(參考版)

2024-11-19 04:31本頁面
  

【正文】 340:11371143.內(nèi)容總結(jié)
(1)宮頸癌及癌前病變規(guī)范化診療指南(試行)
。101(2):234237. Epub 2005 Nov 21. 26. Keys HM, Bundy BN, Stehman FB, et al. Cisplatin, radiation, and adjuvant hysterectomy pared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med 1999。113(6):719724. 24. Landoni F, Zanagnolo V, LovatoDiaz L, et al. Ovarian metastases in earlystage cervical cancer (IA2IIA): a multicenter retrospective study of 1965 patients (a Cooperative Task Force study). Int J Gynecol Cancer 2007。s operation): A parative study with laparoscopicassisted vaginal radical hysterectomy2007。99:S1526. Epub 2005 Sep 2. 21. Plante M, Renaud MC, Hoskins IA, Roy M. Vaginal radical trachelectomy: a valuable fertilitypreserving option in the management of earlystage cervical cancer. A series of 50 pregnancies and review of the literature. Gynecol Oncol 2005。93:469473.19. Bernardini M, Barrett J, Seaward G, et al. Pregnancy outes in patients after radical trachelectomy. Am J Obstet Gynecol 2003。16:11001108. 18. Koliopoulos G, Sotiriadis A, Kyrgiou M, et al. Conservative surgical methods for FIGO stage IA2 squamous cervical carcinoma and their role in preserving women39。25:29522965. 16. Pearcey R, Miao Q, Kong W, et al. Impact of adoption of chemoradiotherapy on the oute of cervical cancer in Ontario: results of a populationbased cohort study. J Clin Oncol 2007。350:535540. 14. Rose PG, Ali S, Watkins E, et al. Longterm followup of a randomized trial paring concurrent single agent cisplatin, cisplatinbased bination chemotherapy, or hydroxyurea during pelvic irradiation for locally advanced cervical cancer: a Gynecologic Oncology Group Study. J Clin Oncol 2007。13:773782. 12. Benedet JL, Bender H, Jones H 3rd, et al. FIGO staging classifications and clinical practice guidelines in the management of gynecologic cancers. FIGO Committee on Gynecologic Oncology. Int J Gynaecol Obstet 2000。38(3):189197. Epub 2007 Jan 25.10. American College of Obstetricians and practice bulletin. Diagnosis and treatment of cervical carcinomas. Number 35, May 2002. Int J Gynaecol Obstet 2002。369(9576):18611868. 8. FUTURE II Study Group. Quadrivalent vaccine against human papillomavirus to prevent highgrade cervical lesions. N Engl J Med 2007。6:271278.7. Ault KA。55:74108. 5. Kamangar F, Dores GM, Anderson WF. Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol 2006。107(8):17111742. 3. Sherman ME, Wang SS, Carreon J, Devesa SS. Mortality trends for cervical squamous and adenocarcinoma in the United States. Relation to incidence and survival. Cancer 2005。 參考文獻1. Jemal A, Siegel R, Ward E, et al. Cancer Statistics, 2007. CA Cancer J Clin 2007。西方國家的經(jīng)驗顯示,宮頸癌的發(fā)生率在密切篩查的人群中減少了70%90%。因此,有必要規(guī)范宮頸癌的診斷與治療。近年來大量研究表明,宮頸癌的發(fā)病年齡呈年輕化趨勢。我國每年約有新發(fā)病例13萬, 占世界宮頸癌新發(fā)病例總數(shù)的28%。 附 錄 4宮頸癌的基本情況宮頸癌是常見的婦科惡性腫瘤之一, 發(fā)病率在我國女性惡性腫瘤中居第二位, 僅次于乳腺癌。 最佳總療效的評價最佳總療效的評價是指從治療開始到疾病進展或復(fù)發(fā)之間所測量到的最小值。 未完全緩解/穩(wěn)定(IR/SD),存在一個或多個非靶病灶和/或腫瘤標志物持續(xù)高于正常值。 病變穩(wěn)定(SD),介于部分緩解和疾病進展之間。 部分緩解(PR),靶病灶最長徑之和與基線狀態(tài)比較,至少減少30%。 病變進展(PD),病變兩徑乘積增大超過25%。 部分緩解(PR),腫瘤最大直徑及最大垂直直徑的乘積縮小達50%,其他病變無增大,持續(xù)超過1個月。+ HPV感染的細胞學(xué)改變包括在低度鱗狀上皮病變內(nèi)。不能評價的激素水平。與年齡和病史不相符的激素水平模式。激素水平評估(只用于陰道涂片)子宮外腺癌子宮頸管腺癌絕經(jīng)后婦女子宮內(nèi)膜細胞,細胞學(xué)良性鱗狀上皮內(nèi)高度病變包括: CIN2 CIN3(包括原位癌)未明確診斷意義的不典型鱗狀細胞* 附 錄 1病人狀況評分1 Karnofsky評分(KPS,百分法)評分見表1。建議放療后使用陰道擴張器。胸部X線片每年拍攝1次,連續(xù)5年后根據(jù)情況而定。.3 IIB及IIB期以上 同步放化療(具體方案詳上述放射治療及增敏化療)9 隨訪對于新發(fā)宮頸癌患者應(yīng)建立完整病案,治療后定期隨訪監(jiān)測。對早期初治宮頸癌患者選擇治療方法時,有高危因素的患者選擇放化療更為有利。.2 IBIIA(4cm)期 可選擇的治療方法:?同步放化療;?廣泛子宮切除和盆腔淋巴清掃、腹主動脈淋巴結(jié)取樣、術(shù)后個體化輔助治療;?新輔助化療后廣泛子宮切除術(shù)和盆腔淋巴結(jié)切除及腹主動脈淋巴結(jié)取樣術(shù)、術(shù)后個體化治療
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