Hasbini Ali, Haie-Meder Christine, Morice Philippe, Chirat Eric, Duvillard Pierre, Lhommé Catherine, Delapierre Monique, Gerbaulet Alain
Department of Radiotherapy, Brachytherapy Service, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, France.
Radiother Oncol. 2002 Oct;65(1):23-8. doi: 10.1016/s0167-8140(02)00212-8.
The vagina is the site most commonly affected by loco-regional failure in endometrial carcinoma (EC). The aim of this study was to evaluate the efficacy of vaginal brachytherapy (BT) combined or not with whole pelvic external radiotherapy (RT) for the treatment of patients with vaginal recurrences from endometrial cancer.
Between 1986 and 1999 25 women were treated at the Institut Gustave Roussy (IGR) for a vaginal relapse (VR) from EC. Patient characteristics were as follows: median age 65 years (range 43-84), histologic type: adenocarcinoma (21 patients); endometrioid carcinoma (three patients); adenoacanthoma (one patient); FIGO staging for initial disease: Ia, three; Ib, eight; Ic, four; II, seven; IIIa, two; IVa, one. The initial tumor was treated by surgery alone in 18 patients, or surgery combined with RT and/or BT in seven patients. A VR occurred in a median interval of 21 months (range 2-89); 10/25 (40%) occurred within the first year following initial treatment. The recurrence was exclusively in the vagina in 18 patients and was associated with parametrial and or nodal involvement in seven patients; it was localized in the upper 1/3 of the vagina in nine patients, in the upper 2/3 or the entire vagina in 11 patients or in the lower 1/3 in five patients. The largest tumor diameter ranged from 10 to 70 mm (median: 25 mm). The treatment of the VR included low-dose rate endocavitary BT in all cases: three patients received endocavitary BT alone, or it was associated with external RT in 22 patients or delivered after surgical removal of the lesion in nine patients. Seven patients were submitted to further irradiation combining endocavitary and interstitial BT.
Local control was achieved in 23 patients (92%). With a follow-up ranging from 4 to 154 months, 13 patients have died (ten due to metastasis, two of intercurrent disease and two due to local tumor progression) and ten patients are alive and disease free. The 3-year actuarial survival was 48%. Late radiation-related sequelae were observed in nine patients (mucous necrosis in one patient, moderate sclerosis in six patients) in an interval varying between 8 and 45 months. The majority of recurrences occurred in patients who had not previously received irradiation, which emphasizes the role of systematic prophylactic post-operative vaginal BT. Extra-vaginal extension (P < 0.001), the tumor size (P < 0.03) and the stage of initial disease (P < 0.01) appeared to have a significant impact on the prognosis.
BT combined with external RT is an efficient treatment for VR from EC even in previously irradiated patients. Poor survival remains related to metastatic dissemination.
阴道是子宫内膜癌（EC）局部区域复发最常累及的部位。本研究旨在评估阴道近距离放疗（BT）联合或不联合全盆腔外照射放疗（RT）治疗子宫内膜癌阴道复发患者的疗效。
1986年至1999年间，25例女性在古斯塔夫·鲁西研究所（IGR）接受了子宫内膜癌阴道复发（VR）的治疗。患者特征如下：中位年龄65岁（范围43 - 84岁），组织学类型：腺癌（21例）；子宫内膜样癌（3例）；腺棘皮癌（1例）；初始疾病的国际妇产科联盟（FIGO）分期：Ia期，3例；Ib期，8例；Ic期，4例；II期，7例；IIIa期，2例；IVa期，1例。18例患者初始肿瘤仅接受手术治疗，7例患者接受手术联合RT和/或BT治疗。VR发生的中位间隔时间为21个月（范围2 - 89个月）；25例中有10例（40%）在初始治疗后的第一年内发生。18例患者复发仅局限于阴道，7例患者复发伴有宫旁和/或淋巴结受累；9例患者复发局限于阴道上1/3，11例患者复发局限于阴道上2/3或整个阴道，5例患者复发局限于阴道下1/3。最大肿瘤直径为10至70毫米（中位值：25毫米）。所有病例的VR治疗均包括低剂量率腔内BT：3例患者仅接受腔内BT，22例患者腔内BT联合外照射放疗，9例患者在手术切除病变后进行腔内BT。7例患者接受了腔内和组织间BT联合的进一步照射。
23例患者（92%）实现了局部控制。随访时间为4至154个月，13例患者死亡（10例死于转移，2例死于并发疾病，2例死于局部肿瘤进展），10例患者存活且无疾病。3年精算生存率为48%。9例患者在8至45个月的间隔期出现了晚期放疗相关后遗症（1例患者出现黏膜坏死，6例患者出现中度硬化）。大多数复发发生在先前未接受过放疗的患者中，这强调了系统性预防性术后阴道BT的作用。阴道外扩展（P < 0.001）、肿瘤大小（P < 0.03）和初始疾病分期（P < 0.01）似乎对预后有显著影响。
BT联合外照射放疗是治疗EC阴道复发的有效方法，即使是先前接受过放疗的患者。生存率低仍然与转移扩散有关。
