宫颈癌是严重威胁女性健康的恶性肿瘤之一,其中局部晚期宫颈癌(LACC)有病灶大、手术困难、预后差等特点,关于其治疗方案争议不断,主要推荐的治疗方案有:盆腔外照射+顺铂同期化疗+阴道近距离放疗,广泛性子宫切除术+盆腔淋巴结切除±主动脉旁淋巴结取样,放化疗后进行辅助性子宫切除术.而在临床治疗中,由于各地区放疗水平不同和患者个体化差异,目前对LACC的治疗方案仍存在多样性.预防性半扩展区域调强适形放疗可以在达到与传统扩展区域放疗相似治疗效果的同时减少并发症的发生,同步放化疗同时加局部热疗可以增强患者对治疗的耐受性.腹主动脉旁淋巴结清扫或活检不一定改善LACC的预后,但可帮助判断预后,对已有髂总动脉旁淋巴结转移的患者有积极意义.对于腔内放疗技术不成熟地区的患者,盆腔外照射加同步化疗后行Ⅰ型筋膜外子宫切除术是可行的治疗方案.%Cervical cancer is one of malignant tumors which causes serious threat to women. Treatment for locally advanced cervical cancer(LACC)has being controversial because of its large lesions,operation difficulty and poor prognosis. Radical concurrent chemoradiotherapy,radical surgery and chemoradiotherapy plus hysterectomy are mainly recommended.In clinical treatments,due to the regional differences in radiotherapy levels and individual differences,the treatments of LACC still exhibit diversity. The therapeutic ratio of prophylactic semiextended field intensity-modulated radiation therapy is similar to conventional prophylactic extended-field radiotherapy,while the former reduces the incidence of toxicity.Chemoradiotherapy plus hyperthermia is well tolerated and causes no additional acute or long-term toxicity compared with chemoradiotherapy alone.There is no significant evidence indicates that para-aortic lymphadenectomy has a positive impact on overall survival in LACC,but it′s useful to predict the prognosis and related to better overall survival in patients with common iliac lymph node metastasis.Pelvic external beam radiotherapy with chemotherapy followed by type Ⅰextra-fascial hysterectomy can be a good alternative for patients who cannot have no access to successful intracavitary brachytherapy.
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