Bingham Brian, Orton Andrew, Boothe Dustin, Stoddard Greg, Huang Y Jessica, Gaffney David K, Poppe Matthew M
Department of Radiation Oncology, Vanderbilt University, Nashville, Tennessee.
Department of Radiation Oncology, University of Utah, Salt Lake City, Utah.
Int J Radiat Oncol Biol Phys. 2017 Apr 1;97(5):1040-1050. doi: 10.1016/j.ijrobp.2016.12.035. Epub 2017 Jan 4.
To evaluate the survival benefit of adding vaginal brachytherapy (BT) to pelvic external beam radiation therapy (EBRT) in women with stage III endometrial cancer.
The National Cancer Data Base was used to identify patients with stage III endometrial cancer from 2004 to 2013. Only women who received adjuvant EBRT were analyzed. Women were grouped according to receipt of BT. Logistic regression modeling was used to identify predictors of receiving BT. Log-rank statistics were used to compare survival outcomes. Cox proportional hazards modeling was used to evaluate the effect of BT on survival. A propensity score-matched analysis was also conducted among women with cervical involvement.
We evaluated 12,988 patients with stage III endometrial carcinoma, 39% of whom received EBRT plus BT. Women who received BT were more likely to have endocervical or cervical stromal involvement (odds ratios 2.03 and 1.77; P<.01, respectively). For patients receiving EBRT alone, the 5-year survival was 66% versus 69% with the addition of BT at 5 years (P<.01). Brachytherapy remained significantly predictive of decreased risk of death (hazard ratio 0.86; P<.01) on multivariate Cox regression. The addition of BT to EBRT did not affect survival among women without cervical involvement (P=.84). For women with endocervical or cervical stromal invasion, the addition of BT significantly improved survival (log-rank P<.01). Receipt of EBRT plus BT was associated with improved survival in women with positive and negative surgical margins, and receiving chemotherapy did not alter the benefit of BT. Propensity score-matched analysis results confirmed the benefit of BT among women with cervical involvement (hazard ratio 0.80; P=.01).
In this population of women with stage III endometrial cancer the addition of BT to EBRT was associated with an improvement in survival for women with endocervical or cervical stromal invasion.
评估在III期子宫内膜癌女性患者中，盆腔外照射放疗（EBRT）联合阴道近距离放疗（BT）的生存获益情况。
利用国家癌症数据库识别2004年至2013年期间的III期子宫内膜癌患者。仅分析接受辅助EBRT的女性。根据是否接受BT对女性进行分组。采用逻辑回归模型确定接受BT的预测因素。使用对数秩统计比较生存结果。采用Cox比例风险模型评估BT对生存的影响。还对有宫颈受累的女性进行了倾向评分匹配分析。
我们评估了12988例III期子宫内膜癌患者，其中39%接受了EBRT联合BT。接受BT的女性更有可能出现宫颈内膜或宫颈间质受累（优势比分别为2.03和1.77；P<0.01）。对于仅接受EBRT的患者，5年生存率为66%，而联合BT时5年生存率为69%（P<0.01）。在多变量Cox回归中，近距离放疗仍然是死亡风险降低的显著预测因素（风险比0.86；P<0.01）。EBRT联合BT对无宫颈受累的女性生存无影响（P=0.84）。对于有宫颈内膜或宫颈间质浸润的女性，联合BT显著提高了生存率（对数秩P<0.01）。接受EBRT联合BT与手术切缘阳性和阴性的女性生存率提高相关，且接受化疗并未改变BT的获益。倾向评分匹配分析结果证实了BT对有宫颈受累女性的益处（风险比0.80；P=0.01）。
在这群III期子宫内膜癌女性患者中，EBRT联合BT与宫颈内膜或宫颈间质浸润女性的生存率提高相关。
