Lee Marette H, Aquino-Parsons Christina, Hoskins Paul J, Lim Peter, Kwon Janice S
Division of Gynaecologic Oncology, University of British Columbia and BC Cancer Agency, Vancouver BC.
J Obstet Gynaecol Can. 2013 Jul;35(7):635-639. doi: 10.1016/S1701-2163(15)30893-8.
To review recurrence patterns and survival outcomes of women receiving preoperative radiotherapy for clinical stage II endometrial cancer in British Columbia.
We performed a retrospective population-based cohort study of all patients with clinical stage II endometrial cancer who were referred to the British Columbia Cancer Agency from 2000 to 2008, deemed ineligible for primary surgery, and therefore offered preoperative radiotherapy followed by surgery. Patient demographics, uterine risk factors, timing and details of treatments, and timing and sites of recurrence were obtained from patient records. Primary outcome measures were the sites and rates of recurrence and recurrence-free survival.
We identified 29 patients with a mean age of 61 years (range 41 to 83) and median follow-up of 3.1 years (range 0.3 to 5.3). Three-year overall survival was 79%, and median recurrence-free survival was 2.5 years. Eight patients had recurrence of disease (27.6%), with a median time to recurrence of 1.3 years, (range 0.4 to 2.7). Six of these eight women had two or more high-risk uterine factors (deep myometrial invasion, grade 3 tumour), ovarian involvement, or adverse histological type (carcinosarcoma), compared with only one of 21 patients without recurrence. Seven of eight women had recurrence outside the radiated volume of tissue. Median survival after recurrence was 1.0 years (range 0.4 to 2.2).
Women with clinical stage II endometrial cancer had a significant risk of recurrence when treated with preoperative radiotherapy followed by surgery. They were more likely to have distant recurrences, implying the need for an alternate treatment paradigm.
回顾不列颠哥伦比亚省临床II期子宫内膜癌患者接受术前放疗后的复发模式和生存结果。
我们对2000年至2008年转诊至不列颠哥伦比亚癌症机构、被认为不适合进行初次手术、因此接受术前放疗后再手术的所有临床II期子宫内膜癌患者进行了一项基于人群的回顾性队列研究。从患者记录中获取患者人口统计学信息、子宫危险因素、治疗时间和细节以及复发时间和部位。主要结局指标为复发部位和率以及无复发生存率。
我们确定了29例患者，平均年龄61岁（范围41至83岁），中位随访时间3.1年（范围0.3至5.3年）。三年总生存率为79%，中位无复发生存期为2.5年。8例患者出现疾病复发（27.6%），复发的中位时间为1.3年（范围0.4至2.7年）。这8名女性中有6名有两个或更多高危子宫因素（肌层深部浸润、3级肿瘤）、卵巢受累或不良组织学类型（癌肉瘤），而21例未复发患者中只有1例有这些情况。8名女性中有7名在放疗组织体积之外复发。复发后的中位生存期为1.0年（范围0.4至2.2年）。
临床II期子宫内膜癌患者接受术前放疗后再手术有显著的复发风险。她们更有可能出现远处复发，这意味着需要一种替代治疗模式。
