Vance Sean, Burmeister Charlotte, Rasool Nabila, Buekers Thomas, Elshaikh Mohamed A
*Departments of Radiation Oncology and †Public Health Science, and ‡Division of Gynecologic Oncology, Department of Women's Health Services, Henry Ford Hospital, Detroit, MI.
Int J Gynecol Cancer. 2016 Feb;26(2):307-12. doi: 10.1097/IGC.0000000000000615.
Adjuvant radiation treatment (ART) has been shown to reduce local recurrences in early-stage endometrial carcinoma (EC); however, this has not translated into improved overall survival (OS) benefit. As a result, some physicians forgo ART, citing successful salvage rates in cases of recurrence. Survival end points were compared between women treated with salvage RT (SRT) for locoregional recurrence and similarly matched women treated upfront with ART.
We identified 40 patients with stage I to II type 1 EC who underwent hysterectomy and received no adjuvant RT but later developed locoregional recurrence and subsequently received SRT. An additional 374 patients who underwent hysterectomy followed by ART during the same period were identified. Patients in the SRT group were matched to those in the ART group based on FIGO (International Federation of Gynecology and Obstetrics) stage and tumor grade in a 1:3 ratio. Disease-specific survival (DSS) and OS were calculated.
A total of 156 women were matched (39:117). Median follow-up was 56 months. The 2 groups were generally well balanced. With regard to the site of tumor recurrence, it was commonly vaginal in the SRT group (74.3% vs 28.6%, P = 0.01). More SRT patients received a combination of pelvic external-beam RT with vaginal brachytherapy (94.8% vs 35%, P < 0.001). The ART group had significantly better 5-year DSS (95% vs 77%, P < 0.001) and 5-year OS (79% vs 72%, P = 0.005) compared with those of the SRT group.
Our study suggests that women who receive SRT for their locoregional recurrence have worse DSS and OS compared with those matched patients who received ART. Further studies are warranted to develop a high-quality cost-effectiveness analysis as well as accurate predictive models of tumor recurrence. Until then, ART should at least be considered in the management of early-stage EC patients with adverse prognostic factors.
辅助放疗（ART）已被证明可降低早期子宫内膜癌（EC）的局部复发率；然而，这并未转化为总体生存率（OS）的改善。因此，一些医生放弃了ART，理由是复发病例的挽救成功率较高。对局部区域复发接受挽救性放疗（SRT）的女性与术前接受ART的匹配女性的生存终点进行了比较。
我们确定了40例I至II期1型EC患者，这些患者接受了子宫切除术且未接受辅助放疗，但后来出现局部区域复发并随后接受了SRT。另外确定了同期374例接受子宫切除术后进行ART的患者。SRT组患者与ART组患者根据国际妇产科联合会（FIGO）分期和肿瘤分级按1:3的比例进行匹配。计算疾病特异性生存率（DSS）和OS。
总共156名女性进行了匹配（39:117）。中位随访时间为56个月。两组总体平衡良好。关于肿瘤复发部位，SRT组常见于阴道（74.3%对28.6%，P = 0.01）。更多SRT患者接受了盆腔外照射放疗与阴道近距离放疗的联合治疗（94.8%对35%，P < 0.001）。与SRT组相比，ART组的5年DSS（95%对77%，P < 0.001）和5年OS（79%对72%）显著更好。
我们的研究表明，与接受ART的匹配患者相比，因局部区域复发接受SRT的女性的DSS和OS更差。有必要进一步开展高质量的成本效益分析以及准确的肿瘤复发预测模型。在此之前，对于具有不良预后因素的早期EC患者，至少应考虑ART治疗。
