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高剂量率阴道近距离放射治疗联合化疗用于手术分期的局限性子宫浆液性癌。

High-dose-rate vaginal brachytherapy with chemotherapy for surgically staged localized uterine serous carcinoma.

作者信息

Damast Shari, Higgins Susan A, Ratner Elena, De Leon Maria C, Mani Sheida, Silasi Dan-Arin, Azodi Masoud, Santin Alessandro, Rutherford Thomas, Schwartz Peter E

机构信息

Department of Therapeutic Radiology.

Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Gynecologic Oncology, Yale University School of Medicine, New Haven, CT, USA.

出版信息

J Contemp Brachytherapy. 2015 Feb;7(1):35-40. doi: 10.5114/jcb.2015.48539. Epub 2015 Jan 26.

DOI:10.5114/jcb.2015.48539
PMID:25829935
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4371058/
Abstract

PURPOSE

To evaluate our institutional experience combining carboplatin-paclitaxel (C/T) chemotherapy with high-dose-rate (HDR) intra-vaginal brachytherapy (IVB) following comprehensive surgical staging in localized uterine serous carcinoma (USC).

MATERIAL AND METHODS

Institutional chart review identified 56 patients with FIGO 2009 stage I-II USC treated between 2000-2010. Patients underwent total hysterectomy, bilateral salpingo-oopherectomy, and comprehensive surgical staging including pelvic and para-aortic lymph node dissection, omentectomy, and peritoneal cytology. Chemotherapy was 6 cycles of C/T, and the IVB dose was 14 Gy in 2 fractions, prescribed to 0.5 cm from the cylinder surface. Kaplan-Meier methods were used to estimate recurrence-free survival (RFS) and overall survival (OS).

RESULTS

The median follow-up time was 49 months (range: 9-145). The 5-yr RFS and OS were 85% and 93%, respectively. In all cases of recurrence (n = 8), the first site of failure was extra-pelvic. There were no isolated vaginal recurrences, however, there was one vaginal apex recurrence recorded at 19 months in a patient with simultaneous lung metastases. Thus, the 2-year vaginal RFS was 98%.

CONCLUSIONS

Excellent vaginal/pelvic control rates were observed. Further study of HDR brachytherapy dose and fractionation in combination with chemotherapy is worthwhile.

摘要

目的

评估我院在局限性子宫浆液性癌（USC）综合手术分期后，将卡铂 - 紫杉醇（C/T）化疗与高剂量率（HDR）阴道近距离放疗（IVB）相结合的经验。

材料与方法

通过回顾我院病历，确定了2000年至2010年间接受治疗的56例国际妇产科联盟（FIGO）2009分期为I-II期的USC患者。患者接受了全子宫切除术、双侧输卵管卵巢切除术以及包括盆腔和腹主动脉旁淋巴结清扫、大网膜切除术和腹腔细胞学检查在内的综合手术分期。化疗采用6个周期的C/T方案，IVB剂量为14 Gy，分2次给予，处方剂量点距离施源器表面0.5 cm。采用Kaplan-Meier方法估计无复发生存期（RFS）和总生存期（OS）。

结果

中位随访时间为49个月（范围：9 - 145个月）。5年RFS和OS分别为85%和93%。在所有复发病例（n = 8）中，首个失败部位均在盆腔外。没有孤立的阴道复发，但有1例患者在19个月时出现阴道残端复发，同时伴有肺转移。因此，2年阴道RFS为98%。

结论

观察到了出色的阴道/盆腔控制率。进一步研究HDR近距离放疗剂量分割与化疗联合应用是值得的。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9933/4371058/7111b28c514f/JCB-7-24399-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9933/4371058/1bcf3cff2fc4/JCB-7-24399-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9933/4371058/7111b28c514f/JCB-7-24399-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9933/4371058/1bcf3cff2fc4/JCB-7-24399-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9933/4371058/7111b28c514f/JCB-7-24399-g002.jpg

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