Sekii Shuhei, Murakami Naoya, Kato Tomoyasu, Harada Ken, Kitaguchi Mayuka, Takahashi Kana, Inaba Koji, Igaki Hiroshi, Ito Yoshinori, Sasaki Ryohei, Itami Jun
Department of Radiation Oncology, National Cancer Center Hospital, Tokyo.
Department of Gynecologic Oncology, National Cancer Center Hospital, Tokyo.
J Contemp Brachytherapy. 2017 Jun;9(3):209-215. doi: 10.5114/jcb.2017.67755. Epub 2017 May 18.
This study was designed to retrospectively analyze outcomes of high-dose-rate (HDR) brachytherapy, with or without external beam radiotherapy (EBRT), in patients with vaginal recurrence of endometrial carcinoma, and to identify factors prognostic of patient outcomes.
The medical records of all patients who underwent HDR brachytherapy for initial recurrence in the vagina of endometrial cancer after definitive surgery between 1992 and 2014 were retrospectively reviewed. All patients underwent either intracavitary brachytherapy (ICBT) or interstitial brachytherapy (ISBT) with or without EBRT. Late toxicity was graded using the EORTC (LENT/SOMA) scale, revised in 1995.
Thirty-seven patients were identified. The median follow-up time was 48 months (range: 6-225 months). Of these 37 patients, 23 underwent ICBT, 14 underwent ISBT, and 26 underwent EBRT. Tumor size at first examination of initial relapse was significantly larger in the ISBT than in the ICBT group. The 4-year respective overall survival (OS), local control (LC), and progression-free survival (PFS) rates in the entire cohort were 81.0%, 77.9%, and 56.8%, respectively. The interval between diagnosis of first recurrence and radiotherapy (< 3 months, ≥ 3 months) was a significant predictor of LC and PFS. OS and LC rates did not differ significantly in the ICBT and ISBT groups. Two patients experienced grade 2 rectal bleeding, and four experienced grade 2 hematuria. No grade 3 or higher late complications were observed.
Salvage HDR brachytherapy is an optimal for treating vaginal recurrence of endometrial carcinoma with acceptable morbidity. Early radiotherapy, including brachytherapy, should be considered for women who experience vaginal recurrence of endometrial cancer.
本研究旨在回顾性分析高剂量率（HDR）近距离放射治疗联合或不联合外照射放疗（EBRT）治疗子宫内膜癌阴道复发患者的疗效，并确定患者预后的预测因素。
回顾性分析1992年至2014年间因子宫内膜癌初次手术后阴道初次复发而接受HDR近距离放射治疗的所有患者的病历。所有患者均接受了腔内近距离放射治疗（ICBT）或组织间近距离放射治疗（ISBT），联合或不联合EBRT。采用1995年修订的欧洲癌症研究与治疗组织（EORTC，LENT/SOMA）量表对晚期毒性进行分级。
共纳入37例患者。中位随访时间为48个月（范围：6 - 225个月）。在这37例患者中，23例接受了ICBT，14例接受了ISBT，26例接受了EBRT。初次复发首次检查时，ISBT组的肿瘤大小显著大于ICBT组。整个队列的4年总生存率（OS）、局部控制率（LC）和无进展生存率（PFS）分别为81.0%、77.9%和56.8%。首次复发诊断与放疗之间的间隔时间（< 3个月，≥ 3个月）是LC和PFS的显著预测因素。ICBT组和ISBT组的OS和LC率无显著差异。2例患者出现2级直肠出血，4例出现2级血尿。未观察到3级或更高等级的晚期并发症。
挽救性HDR近距离放射治疗是治疗子宫内膜癌阴道复发且发病率可接受的最佳方法。对于发生子宫内膜癌阴道复发的女性，应考虑早期放疗，包括近距离放射治疗。
