Calais G, Le Floch O, Descamps P, Vitu L, Lansac J
Hopital Bretonneau, Centre Hospitalier Universitaire de Tours, France.
Int J Radiat Oncol Biol Phys. 1991 Apr;20(4):677-83. doi: 10.1016/0360-3016(91)90008-r.
Total hysterectomy with bilateral salpingo oophorectomy is the traditional treatment for endometrial carcinoma. In an effort to improve local control rates, we have surgically treated our Stage I and II patients with radical hysterectomy and pelvic lymphadenectomy (RH-PL). Between 1976 and 1987 we have treated 179 patients with endometrial adenocarcinoma (125 Stage I and 54 Stage II) with the following modalities. Uterovaginal brachytherapy (60 Gy) was performed first and then 6 weeks later an RH-PL was performed. Twenty-nine patients received external pelvic irradiation (45 Gy) because of tumor invasion beyond the internal two-thirds of the myometrium and/or lymph node involvement. The local control rate was 87% (92% for Stage I, 76% for Stage II). Distant metastases occurred in 24 patients (13%). Five-year actuarial survival rates were 80% for Stage I and 61% for Stage II patients. Prognostic factors were nodal status, histological grading, depth of tumor myometrial invasion, histologic status of the hysterectomy specimen, and peritoneal cytology. Late severe complications occurred for 13 patients (7%). These results are comparable to those published for patients treated with less extensive surgery. We conclude that such an extensive surgery (especially pelvic lymphadenectomy) appears to be useless for all patients with bad prognostic factors requiring pelvic external irradiation. We only still perform external iliac node samples for patients with Stage I grade 1 tumors without deep tumor invasion into the myometrium.
全子宫切除加双侧输卵管卵巢切除术是子宫内膜癌的传统治疗方法。为提高局部控制率，我们对Ⅰ期和Ⅱ期患者采用根治性子宫切除术加盆腔淋巴结清扫术（RH-PL）进行手术治疗。1976年至1987年期间，我们采用以下方式治疗了179例子宫内膜腺癌患者（125例Ⅰ期和54例Ⅱ期）。首先进行子宫阴道近距离放疗（60 Gy），6周后进行RH-PL。29例患者因肿瘤侵犯超过子宫肌层内三分之二和/或淋巴结受累而接受盆腔外照射（45 Gy）。局部控制率为87%（Ⅰ期为92%，Ⅱ期为76%）。24例患者（13%）发生远处转移。Ⅰ期患者的5年精算生存率为80%，Ⅱ期患者为61%。预后因素包括淋巴结状态、组织学分级、肿瘤肌层浸润深度、子宫切除标本的组织学状态和腹膜细胞学检查。13例患者（7%）发生晚期严重并发症。这些结果与采用不太广泛手术治疗的患者所发表的结果相当。我们得出结论，对于所有具有不良预后因素且需要盆腔外照射的患者，这种广泛的手术（尤其是盆腔淋巴结清扫术）似乎并无益处。对于Ⅰ期1级肿瘤且未深入肌层浸润的患者，我们仍仅进行髂外淋巴结取样。
