Yahata Hideaki, Hirakawa Toshio, Fujita Takuji, Ariyoshi Kazuya, Sonoda Kenzo, Amada Satoshi, Kobayashi Hiroaki, Nakano Hitoo
Department of Obstetrics and Gynecology, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, 812-8582, Fukuoka, Japan.
Int J Clin Oncol. 2004 Aug;9(4):317-21. doi: 10.1007/s10147-004-0400-x.
Doxorubicin and cisplatin are the most commonly used chemotherapeutic agents in the treatment of endometrial cancer, but their clinical efficacy is still controversial. The aim of this study was to retrospectively assess the efficacy and toxicity of combination chemotherapy using cisplatin, cyclophosphamide, and anthracy-clines in patients with stage III/IV adenocarcinoma of the endometrium.
Forty patients with advanced endometrial cancer received postoperative adjuvant combination chemotherapy, using cisplatin (50 or 70 mg/m2), cyclophosphamide (500 mg/m2), and one of three anthracyclines (10 patients with doxorubicin [50 mg/m2], 18 with epirubicin [50 mg/m2], and 12 with pirarubicin [40 mg/m2]), from 1987 to 1999. All patients underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy, with pelvic lymph node dissection in 36 patients and paraaortic lymph node biopsy in 38 patients. Patients were considered eligible if they had adnexal metastasis, paraaortic lymph node metastasis, positive peritoneal cytology, or distant metastasis. The patients were divided into two groups: patients with no measurable lesion (group 1; n = 27), and those with residual measurable lesion (group 2; n = 13) after surgery. The response rate and progression-free survival rate were evaluated in group 2.
In group 1, 7 patients (26%) had recurrence, and all of them died of the disease. No patients in stage IIIa (n = 10), however, had recurrence. In group 2, 6 of the 13 (46%) showed response to chemotherapy (complete response [CR], 31%; partial response [PR], 15%). Toxicity was moderate: 10 patients had grade 4 neutropenia; and dose reductions were mandated in 12 patients.
In group 1, the survival of patients receiving chemotherapy was considered favorable, but patients with recurrent lesions had poor prognosis. On the other hand, in group 2, the efficacy of the chemotherapy was almost equal to that reported in the literature; however, this regimen did not contribute to an improvement in the survival rate. In conclusion, a new effective regimen of postoperative adjuvant therapy is highly desirable in patients with measurable residual lesions.
阿霉素和顺铂是治疗子宫内膜癌最常用的化疗药物，但其临床疗效仍存在争议。本研究的目的是回顾性评估顺铂、环磷酰胺和蒽环类药物联合化疗对Ⅲ/Ⅳ期子宫内膜腺癌患者的疗效和毒性。
1987年至1999年，40例晚期子宫内膜癌患者接受了术后辅助联合化疗，使用顺铂（50或70mg/m²）、环磷酰胺（500mg/m²）以及三种蒽环类药物之一（10例使用阿霉素[50mg/m²]，18例使用表柔比星[50mg/m²]，12例使用吡柔比星[40mg/m²]）。所有患者均接受了全腹子宫切除术和双侧输卵管卵巢切除术，36例患者进行了盆腔淋巴结清扫，38例患者进行了腹主动脉旁淋巴结活检。如果患者有附件转移、腹主动脉旁淋巴结转移、腹膜细胞学阳性或远处转移，则被认为符合条件。患者分为两组：术后无可测量病变的患者（第1组；n = 27）和有残余可测量病变的患者（第2组；n = 13）。对第2组评估缓解率和无进展生存率。
在第1组中，7例患者（26%）复发，全部死于该疾病。然而，Ⅲa期（n = 10）的患者均未复发。在第2组中，13例患者中有6例（46%）对化疗有反应（完全缓解[CR]，31%；部分缓解[PR]，15%）。毒性为中度：10例患者出现4级中性粒细胞减少；12例患者需要减少剂量。
在第1组中，接受化疗的患者生存率被认为较好，但复发患者预后较差。另一方面，在第2组中，化疗疗效与文献报道的几乎相同；然而，该方案并未有助于提高生存率。总之，对于有可测量残余病变的患者，非常需要一种新的有效的术后辅助治疗方案。
