Chapman Christopher H, Maghsoudi Kaveh, Littell Ramey D, Chen Lee-May, Hsu I-Chow
Department of Radiation Oncology, University of California San Francisco, San Francisco, CA.
Department of Radiation Oncology, University of California San Francisco, San Francisco, CA; Coastal Radiation Oncology Medical Group, Salinas, CA.
Brachytherapy. 2017 Nov-Dec;16(6):1152-1158. doi: 10.1016/j.brachy.2017.07.002. Epub 2017 Aug 10.
To evaluate clinical outcomes for isolated vaginal recurrence of endometrial cancer without adjuvant therapy treated with salvage external beam radiation therapy (EBRT) and high-dose-rate CT-based inverse-planned brachytherapy.
Thirty women were included in this retrospective study. Median time to first recurrence was 16.7 months, and median age at recurrence was 73 years. Initial grade was 1 or 2 in 19 patients (63%), and 2009 FIGO stage IA in 19 patients. All patients received pelvic EBRT in 1.8 Gy daily fractions to a total of 45 or 50.4 Gy. Interstitial brachytherapy was used in 27 patients (90%). The median total EQD2 dose was 68.3 Gy. Kaplan-Meier estimates of overall survival (OS), cause-specific survival (CSS), progression free survival (PFS), locoregional failure-free survival, and distant failure-free survival (DFFS) were calculated.
Median follow-up was 76.4 months for vital status and 57.7 months for disease status after salvage therapy. The 5-year OS, CSS, PFS, locoregional failure-free survival, and DFFS after salvage therapy were 77%, 83%, 75%, 87%, and 86%. Initial high-grade disease was prognostic for OS, CSS, and DFFS (5-year OS 95% vs. 29%, p = 0.005). Initial stage beyond IA was prognostic for CSS, PFS, and DFFS (5-year CSS 93% vs. 74%, p = 0.025).
Salvage EBRT and high-dose-rate brachytherapy resulted in a high rate of locoregional control. Initial high-grade and advanced stage disease were associated with greater distant failure and cancer-related mortality after salvage therapy.
评估采用挽救性外照射放疗（EBRT）和基于CT的高剂量率逆向计划近距离放疗治疗且未接受辅助治疗的子宫内膜癌孤立性阴道复发的临床结局。
本回顾性研究纳入了30名女性。首次复发的中位时间为16.7个月，复发时的中位年龄为73岁。19例患者（63%）的初始分级为1级或2级，19例患者为2009年国际妇产科联盟（FIGO）IA期。所有患者均接受盆腔EBRT，每日分次剂量为1.8 Gy，总剂量达45或50.4 Gy。27例患者（90%）采用了组织间近距离放疗。EQD2总剂量的中位数为68.3 Gy。计算了总生存（OS）、病因特异性生存（CSS）、无进展生存（PFS）、局部区域无复发生存和远处无复发生存（DFFS）的Kaplan-Meier估计值。
挽救性治疗后，对生存状态的中位随访时间为76.4个月，对疾病状态的中位随访时间为57.7个月。挽救性治疗后的5年OS、CSS、PFS、局部区域无复发生存和DFFS分别为77%、83%、75%、87%和86%。初始高级别疾病对OS、CSS和DFFS具有预后意义（5年OS 95%对29%，p = 0.005）。初始分期超过IA期对CSS、PFS和DFFS具有预后意义（5年CSS 93%对74%，p = 0.025）。
挽救性EBRT和高剂量率近距离放疗导致较高的局部区域控制率。初始高级别和晚期疾病与挽救性治疗后更高的远处复发率和癌症相关死亡率相关。
