Calais G, Vitu L, Descamps P, Body G, Reynaud-Bougnoux A, Lansac J, Bougnoux P, Le Floch O
Hopital Bretonneau, CHU de Tours, France.
Int J Radiat Oncol Biol Phys. 1990 Sep;19(3):523-7. doi: 10.1016/0360-3016(90)90476-z.
In endometrial carcinoma, vaginal vault brachytherapy is performed to improve the local control rate and to decrease vaginal recurrences. To assess the best chronology of this brachytherapy compared to surgery, we have retrospectively analyzed results of treatment of patients treated either with preoperative brachytherapy (60 Gy) and then radical hysterectomy with bilateral salpingo oophorectomy (RH-BSO) (Group 1), or with RH-BSO and then postoperative brachytherapy (60 Gy) (Group 2). There were one hundred twenty-one patients in Group 1 and 63 in Group 2. The mean age was 61.8 years in Group 1 and 64.3 in Group 2. In Group 1, 73% of the patients were Stage I, and 77.6% were in Group 2. The two groups were comparable for histological grading and depth of tumoral invasion into the myometrium. Brachytherapy was delivered with one uterine and two vaginal sources in Group 1 and with three vaginal sources in Group 2. Doses to the reference volume and to reference points were calculated according to ICRU recommendations. Brachytherapy data were similar in the two groups except reference volume, which was smaller in Group 2. Local control rate was 87% in Group 1 and 91% in Group 2. Distant metastasis occurred in 12% of patients in Group 1 and 9% in Group 2. The 5-year actuarial survival rate was 84% in Group 1 and 89% in Group 2. Regarding stage, histological grading, and depth of tumoral invasion, no differences were observed between the two therapeutic groups. The only prognostic factor in the entire population was Stage. The 5-year actuarial survival rate was 91% for Stage I patients and 69% for Stage II (p value less than 0.03). The late severe complication rate was 14% in Group 1 and 7.9% in Group 2, a difference which was not statistically significant. We concluded that since no differences were observed between the two techniques, vaginal brachytherapy should be performed postoperatively when surgery is the first treatment (Stage I or II, grade 1 or 2, and no deep tumoral invasion into the myometrium).
在子宫内膜癌中，进行阴道穹窿近距离放射治疗以提高局部控制率并减少阴道复发。为了评估这种近距离放射治疗与手术相比的最佳时间安排，我们回顾性分析了两组患者的治疗结果，第一组患者先接受术前近距离放射治疗（60 Gy），然后进行根治性子宫切除术加双侧输卵管卵巢切除术（RH-BSO）；第二组患者先进行RH-BSO，然后接受术后近距离放射治疗（60 Gy）。第一组有121例患者，第二组有63例患者。第一组患者的平均年龄为61.8岁，第二组为64.3岁。在第一组中，73%的患者为I期，第二组为77.6%。两组在组织学分级和肿瘤浸润肌层深度方面具有可比性。第一组采用一个子宫源和两个阴道源进行近距离放射治疗，第二组采用三个阴道源。根据国际辐射单位与测量委员会（ICRU）的建议计算参考体积和参考点的剂量。除参考体积外，两组的近距离放射治疗数据相似，第二组的参考体积较小。第一组的局部控制率为87%，第二组为91%。第一组12%的患者发生远处转移，第二组为9%。第一组的5年精算生存率为84%，第二组为89%。在分期、组织学分级和肿瘤浸润深度方面，两组治疗组之间未观察到差异。整个人群中唯一的预后因素是分期。I期患者的5年精算生存率为91%，II期为69%（p值小于0.03）。第一组的晚期严重并发症发生率为14%，第二组为7.9%，差异无统计学意义。我们得出结论，由于两种技术之间未观察到差异，当手术为首选治疗方法（I期或II期，1级或2级，且肿瘤未深度浸润肌层）时，阴道近距离放射治疗应在术后进行。
