Small W, Mahadevan A, Roland P, Vallow L, Zusag T, Fishman D, Massad S, Rademaker A, Kalapurakal J A, Chang S, Lurain J
Section of Radiation Oncology, Robert H Lurie Cancer Center Northwestern University, Chicago, Illinois, USA.
Cancer J. 2000 Nov-Dec;6(6):394-400.
The purpose of this study was to determine the toxicity, patterns of recurrence, and survival in high-risk endometrial cancer patients treated with whole-abdominal radiation.
All patients with endometrial cancer treated at Northwestern University since 1994 and at Rush University since 1993 were retrospectively reviewed. Patients believed to be at high risk for intra-abdominal recurrence and who received whole-abdominal radiation were reviewed for this study.
A total of 30 patients completed whole-abdominal radiation (WAR) and were available for study. The mean and median follow-up was 2.3 and 2.1 years, respectively, with a range of 0.13 to 6.1 years. Seventy-eight percent of the cohort received surgical staging with bilateral salpingo-oophorectomy/total abdominal hysterectomy/lymph node sampling. Forty-seven percent of the patients were found to have serous histology as a component of their tumor. Surgical staging results included 19% stage 1B, 4% stage IC, 8% stage IIB, 37% stage IIIA, 26% stage IIIC, and 7% stage IVB. Two patients had gross residual disease at the completion of surgery. Megestrol acetate (Megace) was used as an adjuvant treatment in 37% of patients, and no cases received initial chemotherapy. All patients received WAR with a mean total dose and dose per fraction of 2620 and 143 cGy, respectively. Twenty-two percent of patients received a para-aortic boost. The mean total pelvic dose was 4956 cGy. Seventy percent of patients received a vaginal cuff boost. Eight percent of patients had grade 3 acute gastrointestinal morbidity, and 4% had grade 4 acute gastrointestinal morbidity. No other grade 3 or greater acute or long-term morbidity was noted. At last follow-up, seven (23%) patients had experienced recurrence. The pattern of first recurrence was 0% in the vaginal cuff, 3% other vaginal, 7% pelvic, 7% upper abdominal, 3% lung, 7% bone, and 7% para-aortic lymph nodes. Ultimate recurrences were similar. At last follow-up, 77% patients had no evidence of disease, 13% were alive with disease, and 10% had died of disease.
Utilizing a conservatrive total whole-abdominal radiation dose and limited para-aortic nodal boost resulted in very tolerable treatments. The patterns of recurrence and survival in this early report are encouraging.
本研究旨在确定接受全腹放疗的高危子宫内膜癌患者的毒性、复发模式及生存率。
回顾性分析了1994年以来在西北大学以及1993年以来在拉什大学接受治疗的所有子宫内膜癌患者。本研究纳入了被认为有腹腔内复发高风险且接受全腹放疗的患者。
共有30例患者完成全腹放疗（WAR）并可用于研究。平均随访时间和中位随访时间分别为2.3年和2.1年，范围为0.13至6.1年。78%的队列患者接受了双侧输卵管卵巢切除术/全腹子宫切除术/淋巴结取样的手术分期。47%的患者肿瘤组织学类型为浆液性。手术分期结果包括19%为1B期，4%为IC期，8%为IIB期，37%为IIIA期，26%为IIIC期，7%为IVB期。两名患者在手术结束时存在肉眼可见的残留病灶。37%的患者使用醋酸甲地孕酮（Megace）作为辅助治疗，无一例患者接受初始化疗。所有患者均接受WAR，平均总剂量和分次剂量分别为2620 cGy和143 cGy。22%的患者接受了腹主动脉旁野加量照射。平均盆腔总剂量为4956 cGy。70%的患者接受了阴道残端加量照射。8%的患者发生3级急性胃肠道不良反应，4%的患者发生4级急性胃肠道不良反应。未观察到其他3级或更严重的急性或长期不良反应。在最后一次随访时，7例（23%）患者出现复发。首次复发模式为阴道残端0%，其他阴道部位3%，盆腔7%，上腹部7%，肺部3%，骨骼7%，腹主动脉旁淋巴结7%。最终复发情况相似。在最后一次随访时，77%的患者无疾病证据，13%的患者带瘤生存，10%的患者死于疾病。
采用保守的全腹放疗总剂量和有限的腹主动脉旁淋巴结野加量照射，治疗耐受性良好。这份早期报告中的复发模式和生存率令人鼓舞。
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