Calais G, Descamps P, Vitu L, Body G, Lansac J, Bougnoux P, Le Floch O
Clinique d'Oncologie et Radiothérapie, Centre Hospitalier, Universitaire de Tours, France.
Gynecol Oncol. 1990 Jul;38(1):71-5. doi: 10.1016/0090-8258(90)90014-c.
In our institution endometrial carcinoma stages I and II is treated with uterovaginal brachytherapy and radical hysterectomy with pelvic lymphadenectomy. We have made a retrospective analysis of the results of lymphadenectomy to determine its place in the treatment strategy. Between 1976 and 1986, 155 patients were treated with these modalities (107 were stage I, 48 were stage II). The mean age was 60.2 years. Brachytherapy delivered 60 Gy, and then radical hysterectomy with pelvic lymphadenectomy was performed. Twenty-six patients received pelvic external-beam irradiation because of lymph node involvement and or deep tumor invasion into the myometrium. Fourteen patients (9%) had lymph node involvement. External iliac lymph nodes were involved in 78.5% of these cases. The lymph node involvement rate was higher for patients with stage II disease, patients with grade 3 tumors, and patients in whom there was deep tumor invasion into the myometrium. Pelvic failure rate was 12% for node-negative patients and 36% for node-positive patients. The 5-year actuarial survival rates were 83% for node-negative and 41% for node-positive patients. We administer pelvic external-beam radiotherapy to all stage II patients, grade 2 or 3 patients, and patients in whom there is deep tumor invasion into the myometrium. We do not perform lymphadenectomy on these patients. We perform only external iliac sampling for patients with stage I, grade 1 tumor without deep tumor invasion.
在我们机构，子宫内膜癌I期和II期采用子宫阴道近距离放疗及根治性子宫切除术加盆腔淋巴结清扫术进行治疗。我们对淋巴结清扫术的结果进行了回顾性分析，以确定其在治疗策略中的地位。1976年至1986年期间，155例患者接受了这些治疗方式（I期107例，II期48例）。平均年龄为60.2岁。先进行60 Gy的近距离放疗，然后进行根治性子宫切除术加盆腔淋巴结清扫术。26例患者因淋巴结受累和（或）肿瘤深肌层浸润接受了盆腔外照射。14例患者（9%）有淋巴结受累。其中78.5%的病例髂外淋巴结受累。II期患者、3级肿瘤患者以及肿瘤深肌层浸润患者的淋巴结受累率更高。淋巴结阴性患者的盆腔复发率为12%，淋巴结阳性患者为36%。淋巴结阴性患者的5年精算生存率为83%，淋巴结阳性患者为41%。我们对所有II期患者、2级或3级患者以及肿瘤深肌层浸润患者进行盆腔外照射放疗。我们不对这些患者进行淋巴结清扫术。对于I期、1级肿瘤且无深肌层浸润的患者，仅进行髂外淋巴结取样。
