Direction québécoise de cancérologie, Ministère de la Santé et des Services sociaux du Québec (MSSS), Québec, Canada.
Gynecol Oncol. 2013 Oct;131(1):231-40. doi: 10.1016/j.ygyno.2013.07.084. Epub 2013 Jul 19.
Despite the very good prognosis of endometrial cancer, a number of patients with localized disease relapse following surgery. Therefore, various adjuvant therapeutic approaches have been studied. The objective of this review is to evaluate the efficacy and safety of neoadjuvant and adjuvant therapies in patients with resectable endometrial cancer and to develop evidence-based recommendations.
A review of the scientific literature published between January 1990 and June 2012 was performed. The search was limited to published phase III clinical trials and meta-analyses evaluating the efficacy of neoadjuvant or adjuvant therapies in patients with endometrial carcinoma or carcinosarcoma. A total of 23 studies and five meta-analyses were identified.
The selected literature showed that in patients with a low risk of recurrence, post-surgical observation is safe and recommended in most cases. There are several therapeutic modalities available for treatment of endometrial cancers with higher risk of recurrence, including vaginal brachytherapy, external beam radiotherapy, chemotherapy, or a combination of these.
Considering the evidence available to date, the CEPO recommends the following: (1)post-surgical observation for most patients with a low recurrence risk; (2)adjuvant vaginal brachytherapy for patients with an intermediate recurrence risk; (3)adjuvant pelvic radiotherapy with or without vaginal brachytherapy for patients with a high recurrence risk; addition of adjuvant chemotherapy may be considered as an option for selected patients (excellent functional status, no significant co-morbidities, poor prognostic factors); (4)adjuvant chemotherapy and pelvic radiotherapy with or without brachytherapy and para-aortic irradiation for patients with advanced disease;
尽管子宫内膜癌的预后非常好，但仍有许多局部疾病患者在手术后复发。因此，已经研究了各种辅助治疗方法。本综述的目的是评估新辅助和辅助治疗在可切除子宫内膜癌患者中的疗效和安全性，并制定基于证据的建议。
对 1990 年 1 月至 2012 年 6 月期间发表的科学文献进行了回顾。搜索仅限于评估新辅助或辅助治疗在子宫内膜癌或癌肉瘤患者中的疗效的已发表的 III 期临床试验和荟萃分析。共确定了 23 项研究和 5 项荟萃分析。
所选文献表明，在复发风险低的患者中，手术后观察是安全的，在大多数情况下是推荐的。对于复发风险较高的子宫内膜癌，有几种治疗方法可供选择，包括阴道近距离放疗、外照射放疗、化疗或这些方法的联合应用。
考虑到目前可获得的证据，CEPO 建议如下：（1）对于复发风险低的大多数患者，进行手术后观察；（2）对于复发风险中等的患者，进行辅助阴道近距离放疗；（3）对于复发风险高的患者，进行辅助盆腔放疗加或不加阴道近距离放疗；对于某些患者（良好的功能状态、无明显合并症、不良预后因素），可考虑辅助化疗作为一种选择；（4）对于晚期疾病患者，进行辅助化疗、盆腔放疗加或不加近距离放疗和腹主动脉旁照射。
