Bradford Leslie S, Rauh-Hain Jose Alejandro, Schorge John, Birrer Michael J, Dizon Don S
Departments of *Obstetrics-Gynecology †Medicine, Gillette Center for Gynecologic Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA.
Am J Clin Oncol. 2015 Apr;38(2):206-12. doi: 10.1097/COC.0b013e31829a2974.
Endometrial carcinoma is the most common malignancy of the female reproductive tract. Although most cases are diagnosed at an early stage, endometrial carcinoma carries a poor prognosis when it recurs after previous definitive treatment or when diagnosed at an advanced stage. The purpose of this review is to summarize the contemporary management of recurrent endometrial carcinoma.
A literature review was conducted on the management of advanced, recurrent, or metastatic endometrial cancer to determine the best evidence to support the roles of surgery, radiation, and medical therapy.
Radiation therapy (RT) has a role in the treatment of a local or regional recurrence, especially in the patient who has not had prior RT. For selected patients who experience a loco-regional recurrence and who have been treated with RT, pelvic exenteration may be an option. Those patients with metastatic disease are not curable and should be considered for palliative chemotherapy. The data support the use of carboplatin and paclitaxel as an acceptable alternative to cisplatin-based regimens. For women who progress after first-line treatment, the options are limited. Current clinical trials are evaluating the role of angiogenesis inhibitors and molecularly targeted therapy (including the mammalian target of rapamycin inhibitors and multitargeted tyrosine kinase inhibitors) with the aim of identifying other novel agents that can be exploited for treatment of advanced disease.
The treatment of women with advanced, recurrent, or metastatic endometrial cancer represents an unmet need in oncology. Robust clinical trials are required to explore how to improve on therapy. The incorporation of molecularly targeted agents has the potential to improve outcomes for women who require treatment in both the first-line and second-line settings.
子宫内膜癌是女性生殖道最常见的恶性肿瘤。尽管大多数病例在早期被诊断出来，但子宫内膜癌在先前确定性治疗后复发或在晚期被诊断时预后较差。本综述的目的是总结复发性子宫内膜癌的当代治疗方法。
对晚期、复发性或转移性子宫内膜癌的治疗进行文献综述，以确定支持手术、放疗和药物治疗作用的最佳证据。
放射治疗（RT）在局部或区域复发的治疗中发挥作用，尤其是在未曾接受过先前放疗的患者中。对于某些经历局部区域复发且已接受放疗的患者，盆腔脏器清除术可能是一种选择。那些患有转移性疾病的患者无法治愈，应考虑进行姑息化疗。数据支持使用卡铂和紫杉醇作为基于顺铂方案的可接受替代方案。对于一线治疗后病情进展的女性，选择有限。目前的临床试验正在评估血管生成抑制剂和分子靶向治疗（包括雷帕霉素靶蛋白抑制剂和多靶点酪氨酸激酶抑制剂）的作用，目的是确定可用于治疗晚期疾病的其他新型药物。
晚期、复发性或转移性子宫内膜癌女性的治疗是肿瘤学中未满足的需求。需要进行有力的临床试验来探索如何改进治疗方法。分子靶向药物的纳入有可能改善一线和二线治疗中需要治疗的女性的治疗效果。
