Department of Gynecology and Obstetrics, Georg-August-University, Göttingen.
Department of Radiotherapy, Martin-Luther-University, Halle-Wittenberg, Germany.
Curr Opin Oncol. 2019 Sep;31(5):404-410. doi: 10.1097/CCO.0000000000000558.
This article reviews and interprets studies on adjuvant treatment of endometrial cancer published during the last 18 months.
For patients with intermediate and high intermediate risk endometrial cancer, vaginal brachytherapy remains the adjuvant therapy of choice. New molecular markers might help to define patients in this group for whom observation only is sufficient and women who might have benefitted from external beam radiotherapy. Preliminary results from large randomized controlled trials have shown that in early stage, high-risk endometrial cancer the addition of chemotherapy to external beam radiotherapy (EBRT) did not improve survival. The combination of vaginal brachytherapy with three courses of chemotherapy resulted in similar progression-free and overall survival (3 years) as EBRT. In stage III high-risk endometrial cancer, the addition of chemotherapy to EBRT improved failure-free survival but not overall survival (immature data). Chemotherapy alone had the same efficacy concerning progression-free and overall survival (immature data).
Three large randomized clinical trials on the role of adjuvant radio and/or chemotherapy have so far provided only immature results. Discussions about changes of clinical practice should be postponed until mature data from all three trials are available. The impact of new molecular markers for risk stratification will be assessed in ongoing RCTs.
本文对过去 18 个月发表的关于子宫内膜癌辅助治疗的研究进行了回顾和解读。
对于中高危子宫内膜癌患者，阴道近距离放疗仍然是辅助治疗的首选。新的分子标志物可能有助于确定这组患者中仅观察即可、或可能从外照射放疗中获益的患者。来自大型随机对照试验的初步结果表明，在早期高危子宫内膜癌中，化疗联合外照射放疗（EBRT）并未改善生存。阴道近距离放疗联合三疗程化疗的疗效与 EBRT 相似（3 年无进展和总生存率）。在 III 期高危子宫内膜癌中，化疗联合 EBRT 可改善无失败生存率，但不能改善总生存率（不成熟数据）。单独化疗在无进展和总生存率方面的疗效相同（不成熟数据）。
迄今为止，三项关于辅助放化疗作用的大型随机临床试验仅提供了不成熟的结果。关于临床实践改变的讨论应推迟到所有三项试验的成熟数据可用时再进行。正在进行的 RCT 将评估新的分子标志物用于风险分层的影响。
