Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
Gynecol Oncol. 2013 Sep;130(3):436-40. doi: 10.1016/j.ygyno.2013.06.024. Epub 2013 Jun 22.
The optimal adjuvant therapy in advanced endometrial cancer is controversial. One regimen is concurrent external beam pelvic irradiation (RT) and cisplatin, then carboplatin/paclitaxel. This study reports an institutional experience using this approach in stage III (FIGO 2009) endometrial cancer.
Patients with stage III (FIGO 2009) endometrial cancer who underwent total hysterectomy and bilateral salpingo-oophorectomy at a single institution from 01/2004 to 12/2009 were identified retrospectively. Those treated with adjuvant RT/cisplatin, followed by carboplatin/paclitaxel comprised the study population.
Of the 40 eligible patients, 7 (18%) were stage IIIA and 33 (82%) IIIC. Nineteen patients (48%) were ≥ 60 years of age. Twenty-three (58%) had ≥ 50% myometrial invasion, 30 (75%) lymphovascular invasion, 11 (28%) cervical stromal invasion, and 5 (12%) positive peritoneal cytology. Histology was endometrioid in 32 (80%), serous in 6 (15%), and clear cell in 2 (5%). At a median follow-up of 49 months, the 5-year freedom from relapse was 79% and overall survival 85%. The 5-year rate of vaginal recurrence was 3%, non-vaginal pelvic recurrence 3%, para-aortic recurrence 11%, peritoneal recurrence 5%, and other distant recurrence 11%. Thirty-one patients (78%) were able to complete the planned RT/cisplatin and 4 cycles of carboplatin/paclitaxel. Acute grade 3 toxicity occurred in 10 patients (4 neutropenia, 2 anemia, 1 fatigue, 2 diarrhea). No late toxicity was grade ≥ 3.
These favorable outcomes corroborate those of RTOG 9708. Until prospective data that compare adjuvant therapy regimens mature, concurrent chemoradiation should be strongly considered in stage III endometrial cancer.
晚期子宫内膜癌的最佳辅助治疗仍存在争议。一种方案是同时进行盆腔外照射放疗（RT）和顺铂，然后是卡铂/紫杉醇。本研究报告了在 III 期（FIGO 2009）子宫内膜癌中使用这种方法的机构经验。
回顾性分析了 2004 年 1 月至 2009 年 12 月在单一机构接受全子宫切除术和双侧输卵管卵巢切除术的 III 期（FIGO 2009）子宫内膜癌患者。接受辅助 RT/顺铂治疗，然后接受卡铂/紫杉醇治疗的患者为研究人群。
在 40 名符合条件的患者中，7 名（18%）为 IIIA 期，33 名（82%）为 IIIIC 期。19 名患者（48%）年龄≥60 岁。23 名（58%）有≥50%的子宫肌层浸润，30 名（75%）有淋巴血管侵犯，11 名（28%）有宫颈基质侵犯，5 名（12%）有阳性腹腔细胞学。组织学上，子宫内膜样腺癌 32 例（80%），浆液性腺癌 6 例（15%），透明细胞癌 2 例（5%）。中位随访 49 个月后，无复发生存率为 79%，总生存率为 85%。5 年阴道复发率为 3%，非阴道盆腔复发率为 3%，主动脉旁复发率为 11%，腹膜复发率为 5%，其他远处复发率为 11%。31 名患者（78%）能够完成计划的 RT/顺铂和 4 个周期的卡铂/紫杉醇。急性 3 级毒性发生在 10 名患者（4 名中性粒细胞减少，2 名贫血，1 名疲劳，2 名腹泻）。无晚期毒性≥3 级。
这些良好的结果与 RTOG 9708 的结果相符。在前瞻性比较辅助治疗方案的数据成熟之前，应强烈考虑在 III 期子宫内膜癌中进行同期放化疗。
