Zhejiang Cancer Hospital, Hangzhou, China.
Int J Gynecol Cancer. 2013 May;23(4):685-9. doi: 10.1097/IGC.0b013e3182808232.
The objective of this study was to evaluate the outcome and feasibility of concurrent chemotherapy with paclitaxel plus carboplatin and radiotherapy (RT) in patients with high-risk or advanced endometrial cancer.
A retrospective analysis of patients treated between January 2003 and December 2009 was conducted. Adjuvant therapy consisted of external beam radiation to the pelvis (45-48.6 Gy) and weekly administration of paclitaxel (40 mg/m(2)) plus carboplatin with an area under the curve of 2 administered intravenously during RT. Two further cycles of paclitaxel (175 mg/m(2)) and carboplatin (area under the curve, 5), separated by 4 weeks, were administered at the end of RT for advanced stage disease. Para-aortic RT and/or vault brachytherapy were added at the discretion of the physicians.
A total of 31 patients with a median age of 56 years (31-69 years) were evaluated. The majority had stage III disease (58%), and the most common histology was endometrioid adenocarcinoma (78%). All patients completed the planned RT. The median follow-up time was 64 months (12-86 months). Five patients' conditions progressed, and all 5 died of the disease. Most of the 5 patients were with serous histologic type and advanced stage disease. There was no local recurrence. The 2-, 3-, and 5-year progression-free survival rates were 87%, 84%, and 79%, respectively. The 2-, 3-, and 5-year overall survival rates were 94%, 87%, and 83%, respectively. Toxicity included grade 3/4 neutropenia in 45.2% of patients, gastrointestinal toxicity in 32.3% of patients, and grade 1/2 sensory neuropathy in 38.7% of patients.
Concomitant paclitaxel plus carboplatin and radiation was feasible and well tolerated and resulted in excellent local-regional control. However, distant metastases continued to occur in more advanced-stage patients. This regimen appears reasonable to be tested for efficacy in randomized studies.
本研究旨在评估紫杉醇联合卡铂化疗并同步放疗（RT）治疗高危或晚期子宫内膜癌患者的疗效和可行性。
对 2003 年 1 月至 2009 年 12 月期间接受治疗的患者进行回顾性分析。辅助治疗包括盆腔外照射（45-48.6Gy）和每周紫杉醇（40mg/m²）联合卡铂（RT 期间静脉注射 AUC2）。对于晚期疾病，在 RT 结束时再给予紫杉醇（175mg/m²）和卡铂（AUC5）两个周期，每 4 周 1 次。根据医生的判断，还可以进行腹主动脉放疗和/或穹窿近距离放疗。
共 31 例患者，中位年龄 56 岁（31-69 岁），大多数患者为 III 期疾病（58%），最常见的组织学类型为子宫内膜样腺癌（78%）。所有患者均完成了计划的 RT。中位随访时间为 64 个月（12-86 个月）。5 例患者病情进展，均死于疾病。这 5 例患者大多为浆液性组织学类型和晚期疾病。无局部复发。2、3、5 年无进展生存率分别为 87%、84%和 79%。2、3、5 年总生存率分别为 94%、87%和 83%。毒性反应包括 45.2%的患者出现 3/4 级中性粒细胞减少、32.3%的患者出现胃肠道毒性和 38.7%的患者出现 1/2 级感觉神经毒性。
紫杉醇联合卡铂和放疗是可行的，且患者耐受性良好，可获得良好的局部区域控制。然而，晚期患者仍持续出现远处转移。该方案在随机研究中测试疗效似乎是合理的。
