Division of Gynecologic Oncology, University Hospitals Gasthuisberg, Leuven, Belgium.
Center for Gynecologic Oncology Amsterdam, Netherlands Cancer Institute, Amsterdam, Netherlands.
Int J Gynaecol Obstet. 2018 Oct;143 Suppl 2:37-50. doi: 10.1002/ijgo.12612.
Endometrial cancer is the most common gynecological malignancy in high-income countries. Although the overall prognosis is relatively good, high-grade endometrial cancers have a tendency to recur. Recurrence needs to be prevented since the prognosis for recurrent endometrial cancer is dismal. Treatment tailored to tumor biology is the optimal strategy to balance treatment efficacy against toxicity. Standard treatment consists of hysterectomy and bilateral salpingo-oophorectomy. Lymphadenectomy (with ongoing studies of sentinel node biopsy) enables identification of lymph node positive patients who need adjuvant treatment, including radiotherapy and chemotherapy. Adjuvant radiotherapy is used for Stage I-II patients with high-risk factors and Stage III lymph node negative patients. In advanced disease, a combination of surgery to no residual disease and chemotherapy results in the best outcome. Surgery for recurrent disease is only advocated in patients with a good performance status with a relatively long disease-free interval.
子宫内膜癌是高收入国家最常见的妇科恶性肿瘤。尽管总体预后相对较好,但高级别子宫内膜癌有复发的倾向。需要预防复发,因为复发性子宫内膜癌的预后较差。根据肿瘤生物学量身定制的治疗是平衡治疗效果和毒性的最佳策略。标准治疗包括子宫切除术和双侧输卵管卵巢切除术。淋巴结切除术(正在进行前哨淋巴结活检研究)可识别需要辅助治疗的淋巴结阳性患者,包括放疗和化疗。辅助放疗用于有高危因素的 I 期- II 期患者和 III 期淋巴结阴性患者。在晚期疾病中,手术至无残留疾病和化疗的联合治疗可获得最佳效果。对于疾病无进展间隔较长且身体状况良好的复发性疾病患者,才提倡进行手术治疗。