Zwahlen Daniel R, Schick Ulrike, Bolukbasi Yasemin, Thariat Juliette, Abdah-Bortnyak Roxolyana, Kuten Abraham, Igdem Sefik, Caglar Hale, Ozsaran Zeynep, Loessl Kristina, Belkaaloul Kaouthar Khanfir, Villette Sylviane, Vees Hansjörg
Department of Radiation Oncology, Kantonsspital Graubuenden, Chur, Switzerland; Department of Radiation Oncology, William Buckland Radiotherapy Centre, Alfred Health, Melbourne, Australia.
Department of Radiation Oncology, University Hospital Geneva , Switzerland.
Rare Tumors. 2016 Jun 29;8(2):6052. doi: 10.4081/rt.2016.6052. eCollection 2016 Jun 28.
Uterine carcinosarcomas (UCS) are rare tumors. Consensus regarding therapeutic management in non-metastatic disease is lacking. This study reports on outcome and predictive factors when using postoperative radiotherapy. We analyzed a retrospective analysis in 124 women treated between 1987-2007 in the framework of the Rare-Cancer-Network. Median follow-up was 27 months. Postoperative pelvic EBRT was administered in 105 women (85%) and 92 patients (74%) received exclusive or additional vaginal brachytherapy. Five-year overall survival (OS), disease-free survival (DFS), cancer specific survival (CSS) and locoregional control (LRC) were 51.6% (95% CI 35-73%), 53.7% (39-71%), 58.6% (38-74%) and 48% (38-67%). Multivariate analysis showed that external beam radiation therapy (EBRT) >50Gy was an independent prognostic factor for better OS (P=0.03), CSS (P=0.02) and LRC (P=0.01). Relative risks (RR) for better OS (P=0.02), DFS (P=0.04) and LRC (P=0.01) were significantly associated with younger age (≤60 years). Higher brachytherapy (BT)-dose (>9Gy) improved DFS (P=0.04) and LRC (P=0.008). We concluded that UCS has high systemic failure rate. Local relapse was reduced by a relative risk factor of over three in all stages of diseases when using higher doses for EBRT and brachytherapy. Postoperative RT was most effective in UCS stage I/II-diseases.
子宫癌肉瘤（UCS）是罕见肿瘤。对于非转移性疾病的治疗管理尚无共识。本研究报告了术后放疗的疗效及预测因素。我们对1987年至2007年间在罕见癌症网络框架下接受治疗的124名女性进行了回顾性分析。中位随访时间为27个月。105名女性（85%）接受了术后盆腔外照射放疗（EBRT），92名患者（74%）接受了单纯或额外的阴道近距离放疗。五年总生存率（OS）、无病生存率（DFS）、癌症特异性生存率（CSS）和局部区域控制率（LRC）分别为51.6%（95%CI 35 - 73%）、53.7%（39 - 71%）、58.6%（38 - 74%）和48%（38 - 67%）。多因素分析显示，外照射放疗（EBRT）剂量>50Gy是OS（P = 0.03）、CSS（P = 0.02）和LRC（P = 0.01）更好的独立预后因素。年龄较轻（≤60岁）与更好的OS（P = 0.02）、DFS（P = 0.04）和LRC（P = 0.01）的相对风险（RR）显著相关。更高的近距离放疗（BT）剂量（>9Gy）改善了DFS（P = 0.04）和LRC（P = 0.008）。我们得出结论，UCS具有较高的全身失败率。在疾病的所有阶段，当使用更高剂量的EBRT和近距离放疗时，局部复发的相对风险因素降低了三倍以上。术后放疗在UCS I/II期疾病中最有效。
