Shenfield Carey B, Pearcey Robert G, Ghosh Sunita, Dundas George S
Department of Radiation Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada.
Brachytherapy. 2009 Jul-Sep;8(3):278-83. doi: 10.1016/j.brachy.2008.11.006. Epub 2009 Feb 20.
To review our institution's results with primary low dose rate (LDR) intracavitary brachytherapy using Heyman's capsules for medically inoperable cancer of the endometrium.
The study was a retrospective review of inoperable early-stage endometrial cancer patients at the Cross Cancer Institute in Edmonton, Canada, treated with primary radiotherapy from January 10, 1986 to July 17, 2006. Forty-four patients with International Federation of Gynaecology and Obstetrics (FIGO) clinical Stage I disease were included in the study. Kaplan-Meier survival analysis was performed to obtain estimates of overall survival (OS), disease-free survival, and disease-specific survival (DSS). Tumor grade was assessed as a potential predictor of OS by comparing survival curves using a log-rank test.
The median OS time was 75.5 months (95% confidence interval 55.6-95.3 months). For the entire group, the 5- and 10-year OS was 60.5% and 24.0%, respectively. The 5- and 10-year DSS was 87.7% and 79.7%, respectively. For a subset treated as planned, the 5- and 10-year OS was 54.5% and 34.5%, respectively. The 5- and 10-year DSS was 83.0% and 76.4%, respectively. When stratified by grade, trends in survival analysis are inversely related to grade. Both the trend analysis and the log-rank test were statistically significant at a p<0.05 level.
Our experience with LDR brachytherapy for the treatment of Stage I endometrial cancer is comparable to surgical treatment and to results reported in the literature for high dose rate brachytherapy. Further study that would help define the indications for a primary radiotherapeutic approach in early-stage endometrial cancer may lower current thresholds for recommending primary radiotherapy versus surgery.
回顾本院使用海曼胶囊进行原发性低剂量率（LDR）腔内近距离放射治疗子宫内膜癌且无法进行手术治疗的结果。
本研究是对1986年1月10日至2006年7月17日在加拿大埃德蒙顿十字癌症研究所接受原发性放疗的无法手术的早期子宫内膜癌患者进行的回顾性研究。研究纳入了44例国际妇产科联合会（FIGO）临床I期疾病患者。采用Kaplan-Meier生存分析来估计总生存期（OS）、无病生存期和疾病特异性生存期（DSS）。通过对数秩检验比较生存曲线，将肿瘤分级评估为OS的潜在预测因素。
中位OS时间为75.5个月（95%置信区间55.6 - 95.3个月）。对于整个组，5年和10年OS分别为60.5%和24.0%。5年和10年DSS分别为87.7%和79.7%。对于按计划治疗的亚组，5年和10年OS分别为54.5%和34.5%。5年和10年DSS分别为83.0%和76.4%。按分级分层时，生存分析趋势与分级呈负相关。趋势分析和对数秩检验在p<0.05水平均具有统计学意义。
我们使用LDR近距离放射治疗I期子宫内膜癌的经验与手术治疗相当，且与文献报道的高剂量率近距离放射治疗结果相当。有助于明确早期子宫内膜癌原发性放射治疗方法适应证的进一步研究可能会降低目前推荐原发性放疗与手术治疗的阈值。
