Herrera Fernanda G, Cruz Olalla Santa, Achtari Chahin, Bourhis Jean, Ozsahin Mahmut
Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
Ann Surg Oncol. 2014 Jul;21(7):2390-7. doi: 10.1245/s10434-014-3622-9. Epub 2014 Mar 7.
We retrospectively reviewed the long-term outcome and late side effects of endometrial cancer (EC) patients treated with different techniques of postoperative radiotherapy (PORT).
Between 1999 and 2012, 237 patients with EC were treated with PORT. Two-dimensional external beam radiotherapy (2D-EBRT) was used in 69 patients (30 %), three-dimensional EBRT (3D-EBRT) in 51 (21 %), and intensity-modulated RT (IMRT) with helical Tomotherapy in 47 (20 %). All patients received a vaginal brachytherapy (VB) boost. Seventy patients (29 %) received VB alone.
After a median of 68 months (range, 6-154) of follow-up, overall survival was 75 % [95 % confidence interval (CI), 69-81], disease-free survival was 72 % (95% CI, 66-78), cancer-specific survival was 85 % (95 % CI, 80-89), and locoregional control was 86 % (95 % CI, 81-91). The 5-year estimates of grade 3 or more toxicity and second cancer rates were 0 and 7 % (95 % CI, 1-13) for VB alone, 6 % (95 % CI, 1-11) and 0 % for IMRT + VB, 9 % (95 % CI, 1-17) and 5 % (95 % CI, 1-9) for 3D-EBRT + VB, and 22 % (95 % CI, 12-32) and 12 % (95 % CI, 4-20) for 2D-EBRT + VB (P = 0.002 and P = 0.01), respectively.
Pelvic EBRT should be tailored to patients with high-risk EC because the severe late toxicity observed might outweigh the benefits. When EBRT is prescribed for EC, IMRT should be considered, because it was associated with a significant reduction of severe late side effects.
我们回顾性分析了采用不同术后放疗（PORT）技术治疗的子宫内膜癌（EC）患者的长期预后和晚期副作用。
1999年至2012年间，237例EC患者接受了PORT治疗。69例（30%）患者采用二维体外照射放疗（2D-EBRT），51例（21%）采用三维EBRT（3D-EBRT），47例（20%）采用螺旋断层放疗调强放疗（IMRT）。所有患者均接受阴道近距离放疗（VB）强化治疗。70例（29%）患者仅接受VB治疗。
中位随访68个月（范围6 - 15个月）后，总生存率为75%[95%置信区间（CI），69 - 81]，无病生存率为72%（95%CI，66 - 78），癌症特异性生存率为85%（95%CI，80 - 89），局部区域控制率为86%（95%CI，81 - 91）。单纯VB治疗3级或更高级别毒性和二次癌症发生率的5年估计值分别为0和7%（95%CI，1 - 13），IMRT + VB为6%（95%CI，1 - 11）和0%，3D-EBRT + VB为9%（95%CI，1 - 17）和5%（95%CI，1 - 9），2D-EBRT + VB为22%（95%CI，12 - 32）和12%（95%CI，4 - 20）（P = 0.002和P = 0.01）。
盆腔EBRT应根据高危EC患者进行调整，因为观察到的严重晚期毒性可能超过其益处。当为EC患者开具EBRT处方时，应考虑IMRT，因为它与严重晚期副作用的显著减少相关。
