Radiation Oncology Department, Hospital Clínic Universitari, C/Villarroel 170, 08036, Barcelona, Spain.
Gynecological Cancer Unit, Hospital Clínic Universitari, Barcelona, Spain.
Clin Transl Oncol. 2018 Nov;20(11):1416-1421. doi: 10.1007/s12094-018-1872-x. Epub 2018 Apr 12.
To analyze the impact of age on radiotherapy results based on cancer-specific survival (CSS), vaginal-cuff relapses (VCR) and complications analysis in 438 patients with endometrial carcinoma (EC) receiving postoperative radiotherapy (PRT) divided into three age groups for analysis.
From 2003 to 2015, 438 patients with EC were treated with PRT and divided into three age groups: Group-1: 202 patients < 65 years; Group-2: 210 patients ≥ 65 and < 80 years; Group-3: 26 patients ≥ 80 years. Vaginal toxicity was assessed using the objective LENT-SOMA criteria and RTOG scores were recorded for the rectum, bladder, and small bowel.
Chi square and Student's t tests, Kaplan-Meier survival study for analysis of CSS.
The mean follow-up was 5.6 years in Group-1, 5.6 years in Group-2 and 6.3 years in Group-3 (p = 0.38). No differences were found among the groups in distribution of stage, grade, myometrial invasion, Type 1 vs. 2 EC and VLSI (p = 0.97, p = 0.52, p = 0.35, p = 0.48, p = 0.76, respectively). There were no differences in rectal, bladder and vagina late toxicity (p = 0.46, p = 0.17, p = 0.75, respectively). A better CSS at 5 years was found in Group-1 (p = 0.006), and significant differences were found in late severe small bowel toxicity in Group-3 (p = 0.005). VCR was increased in Group-3 (p = 0.017).
Patients ≥ 65 years had a worse outcome in comparison to younger patients. Late vaginal, rectal and bladder toxicities were similar in the three groups, although an increase of severe late small bowel toxicity led to IMRT in patients ≥ 80 years. Further larger studies are needed including quality of life analysis in patients ≥ 80 years.
分析 438 例接受术后放疗（PRT）的子宫内膜癌（EC）患者的癌症特异性生存（CSS）、阴道袖口复发（VCR）和并发症分析，这些患者根据年龄分为三组进行分析。
2003 年至 2015 年，438 例 EC 患者接受 PRT 治疗，并分为三组：第 1 组：202 例<65 岁；第 2 组：210 例≥65 岁且<80 岁；第 3 组：26 例≥80 岁。使用客观 LENT-SOMA 标准评估阴道毒性，并记录直肠、膀胱和小肠的 RTOG 评分。
卡方检验和学生 t 检验，CSS 的 Kaplan-Meier 生存研究分析。
第 1 组的平均随访时间为 5.6 年，第 2 组为 5.6 年，第 3 组为 6.3 年（p=0.38）。三组之间在分期、分级、肌层浸润、1 型和 2 型 EC 以及广泛的宫颈内膜腺体侵犯（VLSI）分布方面无差异（p=0.97、p=0.52、p=0.35、p=0.48、p=0.76，分别）。直肠、膀胱和阴道晚期毒性无差异（p=0.46、p=0.17、p=0.75，分别）。第 1 组 5 年 CSS 更好（p=0.006），第 3 组晚期严重小肠毒性显著（p=0.005）。第 3 组 VCR 增加（p=0.017）。
与年轻患者相比，≥65 岁的患者结局较差。三组患者的晚期阴道、直肠和膀胱毒性相似，但≥80 岁患者严重晚期小肠毒性增加，导致采用调强放疗。需要进一步开展包括≥80 岁患者生活质量分析在内的更大规模研究。
