Kucera H
Strahlenther Onkol. 1991 Jul;167(7):381-6.
Today the endometrial carcinoma is the most frequent malignant tumor found in female genital tract. Endometrial carcinoma ought to be operated in all cases, if possible. Traditionally some form of adjuvant radiotherapy has been given. Despite the large number of patients treated by combined therapy over the last 30 years, surprisingly there is a lack of hard data on which to establish a theory for an improved outcome. It is generally accepted that the risk of local relapses in the vagina is lowered when postoperative vaginal irradiation is applied. The question of the value of additional external irradiation in stage I endometrial cancer still is unsettled. Only two prospective studies led to the conclusion that only patients with poorly differentiated tumors and with deep infiltration of the myometrium might benefit from additional external radiotherapy. Therefore a simple score for these risk factors is proposed enabling assignment into patient groups of similar risk on the base of a point system due to individual prognostic factors. With a score of one to two points prognosis is very good and adjuvant irradiation seems not to be necessary. With three to four points local vaginal irradiation is recommended, with five and more points additionally external beam irradiation to the pelvis should be given. This is necessary in more than the half of the operated cases of endometrial carcinoma. The indication for such a treatment has become more individual and "high risk" cases are treated more intensively, but "low risk" cases have to be excepted from unnecessary adjuvant therapy. In order to judge an individual case of endometrial cancer histopathologic prognosticators have to be considered. Typical adenocarcinomas have a five-year survival of more than 80%, but unfavourable subtypes (adenosquamous, clear-cell, serous-papillary carcinomas) of only 40%, respectively. Tumor grading and depth of myometrial invasion are of high importance for individual prognosis. The new histopathologic staging system of FIGO (1988) takes these items into account. Only patients with severe internal diseases should be treated with radiation therapy alone. Although radiation therapy alone can cure endometrial cancer (five-year-survival approximately 60%), the survival figures are poorer than for the operation (five-year survival 80%, respectively). It should be outlined that in inoperable cases radiotherapy is the best form of treatment.
如今，子宫内膜癌是女性生殖道中最常见的恶性肿瘤。如果可能的话，所有子宫内膜癌病例都应进行手术治疗。传统上会给予某种形式的辅助放疗。尽管在过去30年中有大量患者接受了联合治疗，但令人惊讶的是，缺乏确凿的数据来建立一种改善治疗效果的理论。人们普遍认为，术后进行阴道照射可降低阴道局部复发的风险。I期子宫内膜癌额外进行体外照射的价值问题仍未解决。仅有两项前瞻性研究得出结论，只有肿瘤分化差且肌层浸润深的患者可能从额外的体外放疗中获益。因此，针对这些风险因素提出了一个简单的评分系统，根据个体预后因素通过积分制将患者分为风险相似的组。得分为1至2分，预后非常好，似乎无需辅助放疗。得分为3至4分，建议进行局部阴道照射，得分为5分及以上，则应额外进行盆腔体外照射。在超过一半的子宫内膜癌手术病例中都有必要这样做。这种治疗的指征变得更加个体化，“高风险”病例得到更积极的治疗，但“低风险”病例必须避免不必要的辅助治疗。为了判断子宫内膜癌的个体病例，必须考虑组织病理学预后指标。典型的腺癌五年生存率超过80%，但不良亚型（腺鳞癌、透明细胞癌、浆液性乳头状癌）的五年生存率分别仅为40%。肿瘤分级和肌层浸润深度对个体预后至关重要。国际妇产科联盟（FIGO，1988年）的新组织病理学分期系统考虑了这些因素。只有患有严重内科疾病的患者才应单独接受放疗。尽管单独放疗可以治愈子宫内膜癌（五年生存率约为60%），但其生存数据比手术治疗的要差（五年生存率分别为80%）。应当明确的是，在无法手术的病例中，放疗是最佳的治疗方式。
