Brown Lindsay C, Petersen Ivy A, Haddock Michael G, Bakkum-Gamez Jamie N, Lee Larissa J, Cimbak Nicole C, Berkowitz Ross S, Viswanathan Akila N
Department of Radiation Oncology, Mayo Clinic, Rochester, MN.
Department of Gynecologic Oncology, Mayo Clinic, Rochester, MN.
Brachytherapy. 2015 Jul-Aug;14(4):433-9. doi: 10.1016/j.brachy.2015.02.194. Epub 2015 Apr 15.
Uterine carcinosarcoma (CS) is an aggressive malignancy and the optimal adjuvant treatment is not well-established. We report outcomes with vaginal brachytherapy (VB) for women with early-stage CS.
A multi-institutional retrospective study of Stage I-II CS treated with hysterectomy, surgical staging, and adjuvant high-dose-rate VB without external-beam pelvic radiotherapy was performed. Rates of vaginal control, pelvic control, locoregional control, disease-free survival, and overall survival were determined using the Kaplan-Meier method.
33 patients were identified. Prescribed VB dose was 21 Gy in three fractions (n = 15 [45%]) or 24 Gy in six fractions (n = 18 [55%]). Eighteen patients (55%) received chemotherapy. Median followup was 2.0 years. Twenty-seven patients (82%) underwent pelvic lymphadenectomy, 5 (15%) had nodal sampling, and 1 (3%) had no lymph node assessment. Relapse occurred in 11 patients (33%), all of whom had lymph node evaluation. Locoregional relapse was a component of failure in 6 patients (18%), of whom 3 (9%) failed in the pelvis alone. Three patients (9%) had simultaneous distant and locoregional relapse (two vaginal, one pelvic). Five additional patients (15%) had distant relapse. Six of the 11 patients (55%) with disease recurrence received chemotherapy. Two-year vaginal control and pelvic control were 94% and 87%. Two-year locoregional control, disease-free survival, and overall survival were 81%, 66%, and 79%.
Despite having early-stage disease and treatment with VB, patients in this series had relatively high rates of local and distant relapse. Patients who undergo lymphadenectomy and VB remain at risk for relapse. Novel treatment strategies are needed.
子宫癌肉瘤（CS）是一种侵袭性恶性肿瘤，最佳辅助治疗方法尚未完全确立。我们报告早期CS患者接受阴道近距离放疗（VB）的治疗结果。
对接受子宫切除术、手术分期及辅助高剂量率VB且未行盆腔外照射放疗的Ⅰ - Ⅱ期CS患者进行多机构回顾性研究。采用Kaplan - Meier法确定阴道控制率、盆腔控制率、局部区域控制率、无病生存率和总生存率。
共确定33例患者。规定的VB剂量为21 Gy分3次（n = 15 [45%]）或24 Gy分6次（n = 18 [55%]）。18例患者（55%）接受了化疗。中位随访时间为2.0年。27例患者（82%）接受了盆腔淋巴结清扫，5例（15%）进行了淋巴结取样，1例（3%）未进行淋巴结评估。11例患者（33%）出现复发，所有复发患者均进行了淋巴结评估。局部区域复发是6例患者（18%）治疗失败的组成部分，其中3例（9%）仅在盆腔复发。3例患者（9%）同时出现远处和局部区域复发（2例阴道复发，1例盆腔复发）。另有5例患者（15%）出现远处复发。11例疾病复发患者中有6例（55%）接受了化疗。两年阴道控制率和盆腔控制率分别为94%和87%。两年局部区域控制率、无病生存率和总生存率分别为81%、66%和79%。
尽管本系列患者处于疾病早期且接受了VB治疗，但局部和远处复发率相对较高。接受淋巴结清扫和VB治疗的患者仍有复发风险。需要新的治疗策略。
