surgoncoКреативная хирургия и онкологияCreative surgery and oncology2076-30932307-0501Башкирский государственный медицинский университет10.24060/2076-3093-2022-12-2-128-138surgonco-694Research ArticleОБЗОР ЛИТЕРАТУРЫREVIEWSСовременные тенденции диагностики и лечения отдаленных метастазов рака шейки маткиModern diagnostics and treatment of distant metastasis of cervical cancerhttps://orcid.org/0000-0001-5542-9531МинязеваР. К.MinyazevaR. K.

 кафедра акушерства и гинекологии № 1

 Уфа 

 Department of Obstetrics and Gynecology No. 1 

 Ufa 

Dr.gubaydullina@mail.ruhttps://orcid.org/0000-0002-1641-9952БатталоваГ. Ю.BattalovaG. Y.

 д.м.н., доцент, кафедра акушерства и гинекологии № 1, радиотерапевтическое отделение № 3

 Уфа 

Dr. Sci. (Med.), Assoc. Prof., Department of Obstetrics and Gynecology No. 1, Radiotherapy Unit No. 3 

 Ufa 

https://orcid.org/0000-0002-2908-8275СахаутдиноваИ. В.SakhautdinovaI. V.

д.м.н., кафедра акушерства и гинекологии № 1

 Уфа 

Dr. Sci. (Med.), Department of Obstetrics and Gynecology No. 1 

 Ufa 

https://orcid.org/0000-0001-9499-5632ГилязоваИ. Р.GilyazovaI. R.

 к.б.н., доцент, кафедра медицинской генетики и фундаментальной медицины, лаборатория молекулярной  генетики человека

 Уфа 

Cand. Sci. (Biol.), Assoc. Prof., Department of Medical Genetics and Fundamental Medicine, Laboratory of Human Molecular Genetics 

 Ufa 

Башкирский государственный медицинский университетРоссияBashkir State Medical UniversityRussian FederationБашкирский государственный медицинский университет; Республиканский клинический онкологический диспансерРоссияBashkir State Medical University; Republican Clinical Oncology DispensaryRussian FederationБашкирский государственный медицинский университет; Институт биохимии и генетики Уфимского федерального научного центра РАНРоссияBashkir State Medical University; Institute of Biochemistry and Genetics, Ufa Federal Research Centre of the Russian Academy of SciencesRussian Federation202215072022122128138Copyright © Минязева Р.К., Батталова Г.Ю., Сахаутдинова И.В., Гилязова И.Р., 20222022Минязева Р.К., Батталова Г.Ю., Сахаутдинова И.В., Гилязова И.Р.Minyazeva R.K., Battalova G.Y., Sakhautdinova I.V., Gilyazova I.R.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.surgonco.ru/jour/article/view/694

Рак шейки матки представляет собой серьезную проблему для здоровья женщин всего мира. Несмотря на программы скрининга населения, внедрение вакцинации, прецизионное изучение процессов патогенеза, разработки диагностики и тактики лечения пациенток, количество случаев ежегодно растет. Мы все чаще наблюдаем прогрессирование заболевания, в частности метастатический рак шейки матки. Прогноз для пациенток данной группы оставляет желать лучшего. Мы рассмотрели соответствующую литературу, в которой описаны методы диагностики и лечения метастатического рака шейки матки. Описанные варианты лечения и показатели выживаемости зависят от локализации метастатических очагов и путей метастазирования. У пациенток с гематогенными метастазами более плохой прогноз в отличие от пациенток с лимфатическими метастазами. С диагностической точки зрения эффективными инструментами для выявления отдаленных метастазов по-прежнему являются фтор-2-дезокси-D-глюкозно-позитронно-эмиссионная томография (ФДГ-ПЭТ) и ПЭТ-компьютерная томография. При лимфогенных метастазах эффективна адъювантная химиотерапия и одномоментная химиолучевая терапия.Резекция гематогенных метастатических очагов в легких и/или химиотерапия являются тактикой выбора для борьбы с рецидивирующим метастатическим раком шейки матки. Соответственно, для пациенток с раком шейки матки IVB стадии оптимальным выбором является химиолучевая терапия. Мультимодальная терапия показала лучшие прогнозы выживаемости. При олигометастатическом поражении головного мозга показана стереотаксическая радиохирургия или краниотомия, при этом результаты лечения и показатели выживаемости были выше в случаях комбинации данных методов с лучевой терапией в объеме облучения всего головного мозга. Однако при наличии множественных метастазов в головной мозг или экстракраниальных очагов метастазирования тактикой выбора может быть только химиотерапия в сочетании с паллиативным облучением всего головного мозга.

Cervical cancer comprises a major female health problem worldwide. Despite population screening programmes, broad vaccination, precision pathogenesis studies and emergent diagnostics and treatment strategies, its prevalence is rising by year. We increasingly report the spread of disease, particularly of metastatic cervical cancer. The such patients’ prognosis is far from favourable. We review the literature relevant to diagnostic and treatment options in metastatic cervical cancer. The options and survival rates described vary by the locality of metastatic lesions and routes of metastasis. Patients with haematogenous metastases have a worse prognosis than patients with lymphogenous ones. From a diagnostic point of view, 2-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG PET) and PET-computed tomography remain efficacious for detecting distant metastases. Adjuvant chemotherapy and concurrent chemoradiotherapy are effective in lymphogenous metastases. Haematogenous lung metastases resection and/or chemotherapy are the tactics of choice to contain relapsed metastatic cervical cancer. Accordingly, chemoradiotherapy is the optimal choice in patients with stage IVB cervical cancer. Multimodal therapy has revealed better survival prognosis. Stereotactic radiosurgery or craniotomy is indicated in oligometastatic brain lesions, with treatment outcomes and survival rates improving for the techniques’ combination with whole-brain radiation therapy. However, in multiple metastasis to brain or extracranial metastasis, chemotherapy combined with palliative whole-brain radiation are left as the only option.

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The authors declare that there are no conflicts of interest present.