Cannon G M, Geye H, Terakedis B E, Kushner D M, Connor J P, Hartenbach E M, Bradley K A
Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA.
Gynecol Oncol. 2009 May;113(2):176-80. doi: 10.1016/j.ygyno.2008.12.029. Epub 2009 Feb 12.
To evaluate locoregional control, disease free survival, and overall survival in patients treated with surgery and adjuvant radiation for stage II adenocarcinoma of the endometrium. Secondary goals include identification of prognostic factors and the comparison of toxicity profiles after vaginal cuff brachytherapy (VB) alone or combined with pelvic external beam radiation therapy (EXT).
All patients receiving adjuvant radiation at the University of Wisconsin following surgery for FIGO stage II adenocarcinoma of the endometrium between January 1991 and December 2006 were retrospectively reviewed.
Between January 1991 and December 2006, 71 patients with FIGO stage II adenocarcinoma of the endometrium (23 stage IIA, 48 stage IIB) received adjuvant radiation at the University of Wisconsin. Fifty patients were treated with EXT and VB, twenty with VB alone, and one with EXT alone. At a mean follow-up of 5.1 years (range, 0.5-16.8 years), 5-year overall and disease-free survival were both 82%. Factors associated with an increased risk for recurrence include depth of myometrial invasion (p=0.005) and lymphovascular invasion (p=0.02). Receiving EXT was significantly associated with increased depth of myometrial invasion (p=0.007), higher grade (p=0.003), and less extensive surgery (p=0.01). Of the nine recurrences, three were initially local and six were distant recurrences alone. Grade 2 or greater acute and late side effects were significantly greater with EXT therapy compared to VB alone (p<0.0001 and p=0.02, respectively), although severe toxicities (grade 3 or greater) were limited with either modality.
Local recurrence rates remain low after surgery and adjuvant radiation therapy for stage II endometrial cancer using a combination of VB and EXT tailored to the surgical and pathologic features. VB alone resulted in fewer toxicities without an increased recurrence risk compared to the combination of EXT and VB, suggesting that VB without EXT is sufficient for patients with low-risk histopathologic features and comprehensive surgical staging with complete lymphadenectomy.
评估接受手术及辅助放疗的子宫内膜II期腺癌患者的局部区域控制、无病生存期和总生存期。次要目标包括确定预后因素，以及比较单纯阴道残端近距离放疗（VB）或联合盆腔外照射放疗（EXT）后的毒性反应情况。
对1991年1月至2006年12月间在威斯康星大学接受子宫内膜FIGO II期腺癌手术后接受辅助放疗的所有患者进行回顾性分析。
1991年1月至2006年12月间，71例子宫内膜FIGO II期腺癌患者（23例IIA期，48例IIB期）在威斯康星大学接受了辅助放疗。50例患者接受了EXT和VB治疗，20例仅接受VB治疗，1例仅接受EXT治疗。平均随访5.1年（范围0.5 - 16.8年），5年总生存率和无病生存率均为82%。与复发风险增加相关的因素包括肌层浸润深度（p = 0.005）和淋巴管浸润（p = 0.02）。接受EXT与肌层浸润深度增加（p = 0.007）、分级较高（p = 0.003）及手术范围较小（p = 0.01）显著相关。在9例复发患者中，3例最初为局部复发，6例仅为远处复发。与单纯VB治疗相比，EXT治疗的2级或更高级别的急性和晚期副作用明显更多（分别为p < 0.0001和p = 0.02），不过两种治疗方式的严重毒性反应（3级或更高）都很有限。
对于II期子宫内膜癌，采用根据手术和病理特征量身定制的VB和EXT联合治疗方案，术后辅助放疗后的局部复发率仍然较低。与EXT和VB联合治疗相比，单纯VB治疗导致的毒性反应更少，且复发风险没有增加，这表明对于具有低风险组织病理学特征且进行了包括完整淋巴结清扫的全面手术分期的患者，不进行EXT的VB治疗就足够了。
