Tewari K, Cappuccini F, Brewster W R, DiSaia P J, Berman M L, Manetta A, Puthawala A, Nisar Syed A M, Kohler M F
Division of Gynecologic Oncology, University of California, Irvine-Medical Center, 101 The City Drive, Orange, California, 92868, USA.
Gynecol Oncol. 1999 Sep;74(3):416-22. doi: 10.1006/gyno.1999.5487.
The aim of this study was to evaluate the efficacy of interstitial brachytherapy in the management of vaginal recurrences of endometrial carcinoma.
Thirty patients received interstitial irradiation, with or without external beam radiotherapy. They were followed for a minimum of 5 years or until death.
The median age was 66 years at initial diagnosis of endometrial cancer. FIGO stages included Stage I (n = 18), Stage II (n = 7), and Stage III (n = 5). All patients were treated originally by total abdominal hysterectomy and bilateral salpingo-oophorectomy, with or without lymphadenectomy, and 13 (43%) also received postoperative adjuvant whole pelvis radiotherapy as part of their primary treatment. Vaginal recurrences were diagnosed at a mean interval of 29 months after hysterectomy (range, 3-119 months). No patient had clinical evidence of pelvic sidewall extension or of distant metastatic disease. All patients were treated with interstitial brachytherapy; each implant delivered a mean maximal tumor dose of 25.5 Gy. Eighteen patients (60%) also received external beam radiotherapy (mean dose, 48 Gy) as part of their treatment for vaginal recurrence. Twenty-eight patients (93%) experienced a complete clinical response. Ten patients relapsed in the vagina (n = 5) or at distant sites (n = 5). Eleven patients are dead of disease. From the time of vaginal recurrence, the median overall survival was 60 months and the cause of death adjusted 5-year survival rate was 65%. Major morbidity included radiation proctitis (n = 2), fistula (n = 2), and radiation stricture (n = 1).
Interstitial irradiation resulted in favorable local control as well as a 5-year survival rate and morbidity comparable to that reported previously for conventional brachytherapy.
本研究旨在评估组织间近距离放疗在子宫内膜癌阴道复发治疗中的疗效。
30例患者接受了组织间照射，部分联合外照射放疗。对他们进行了至少5年的随访或直至死亡。
子宫内膜癌初诊时的中位年龄为66岁。国际妇产科联盟（FIGO）分期包括Ⅰ期（n = 18）、Ⅱ期（n = 7）和Ⅲ期（n = 5）。所有患者最初均接受了全腹子宫切除术及双侧输卵管卵巢切除术，部分联合或不联合淋巴结清扫术，其中13例（43%）作为初始治疗的一部分还接受了术后辅助全盆腔放疗。阴道复发的诊断平均在子宫切除术后29个月（范围3 - 119个月）。没有患者有盆腔侧壁扩展或远处转移疾病的临床证据。所有患者均接受组织间近距离放疗；每次植入的平均最大肿瘤剂量为25.5 Gy。18例患者（60%）作为阴道复发治疗的一部分还接受了外照射放疗（平均剂量48 Gy）。28例患者（93%）获得了完全临床缓解。10例患者在阴道（n = 5）或远处部位（n = 5）复发。11例患者死于疾病。从阴道复发时起，中位总生存期为60个月，校正后的5年生存率为65%。主要并发症包括放射性直肠炎（n = 2）、瘘（n = 2）和放射性狭窄（n = 1）。
组织间照射导致了良好的局部控制，以及与先前报道的传统近距离放疗相当的5年生存率和并发症发生率。
