Pereira Elena B, De Brian, Kolev Valentin, Zakashansky Konstantin, Green Sheryl, Dottino Peter, Gupta Vishal
*Division of Gynecologic Oncology, Departments of Obstetrics, Gynecology and Reproductive Science, and †Radiation Oncology, Mount Sinai Hospital, Mount Sinai Health System, New York, NY.
Int J Gynecol Cancer. 2016 Feb;26(2):341-7. doi: 10.1097/IGC.0000000000000589.
Our aim was to assess current surgical practices and use of adjuvant therapy in the treatment of FIGO (International Federation of Gynecology and Obstetrics) stage I endometrioid endometrial cancer.
A 19-question survey was developed and sent to all Society of Gynecologic Oncologist members by e-mail. Data were collected anonymously using Internet-based survey software. Respondents were asked questions regarding preoperative evaluation, surgical approach, lymph node dissection (LND), and adjuvant therapy.
A total of 1399 surveys were distributed, 320 (23%) members completed the survey. Ninety-seven percent of respondents were gynecologic oncologists or fellows, and 87% treat 30 or more endometrial cancer patients yearly. Respondents were more likely to order preoperative tests such as computed tomography abdomen/pelvis and CA-125 for biopsy-proven grade 3 disease versus grade 1 (82% vs 29%). Robot-assisted laparoscopy was the preferred surgical approach (66%), followed by conventional laparoscopy (21%). Twenty-six percent of respondents perform LND in all cases. Forty-eight percent describe their LND as complete, to the level of the inferior mesenteric artery. Adjuvant therapy was recommended more often with increasing myometrial invasion, tumor grade, and lymphovascular space invasion. Vaginal brachytherapy was the most commonly recommended adjuvant therapy for stage IA. For stage IB, grade 3, positive lymphovascular space invasion disease, respondents were more likely to combine vaginal brachytherapy with external beam radiotherapy and/or chemotherapy. Older patients were more likely to have adjuvant therapy in earlier stages of disease than younger patients.
Our findings demonstrate that respondents are individualizing care based on preoperative, intraoperative, and pathologic findings. As expected, adjuvant treatment is recommended for patients with higher stage and grade disease. Robot-assisted hysterectomy and chemotherapy are now commonly used in the management of this disease. We anticipate that new trends will continue to emerge as results from additional studies become available.
我们的目的是评估目前在治疗国际妇产科联盟（FIGO）I期子宫内膜样子宫内膜癌时的手术操作及辅助治疗的使用情况。
设计了一份包含19个问题的调查问卷，并通过电子邮件发送给所有妇科肿瘤学会成员。使用基于互联网的调查软件匿名收集数据。向受访者询问了有关术前评估、手术方式、淋巴结清扫（LND）和辅助治疗的问题。
共发放了1399份调查问卷，320名（23%）成员完成了调查。97%的受访者为妇科肿瘤学家或研究员，87%的人每年治疗30例或更多子宫内膜癌患者。与1级疾病相比，受访者更倾向于为活检证实的3级疾病进行术前检查，如腹部/盆腔计算机断层扫描和CA - 125检测（82%对29%）。机器人辅助腹腔镜检查是首选的手术方式（66%），其次是传统腹腔镜检查（21%）。26%的受访者在所有病例中都进行LND。48%的人将他们的LND描述为完整的，至肠系膜下动脉水平。随着肌层浸润、肿瘤分级和淋巴管间隙浸润的增加，辅助治疗的推荐频率更高。阴道近距离放射治疗是IA期最常推荐的辅助治疗。对于IB期、3级、淋巴管间隙浸润阳性的疾病，受访者更倾向于将阴道近距离放射治疗与体外放射治疗和/或化疗联合使用。老年患者在疾病早期比年轻患者更有可能接受辅助治疗。
我们的研究结果表明，受访者根据术前、术中和病理结果进行个体化治疗。正如预期的那样，对于更高分期和分级的疾病患者推荐辅助治疗。机器人辅助子宫切除术和化疗现在常用于这种疾病的管理。我们预计随着更多研究结果的出现，新的趋势将继续出现。
