Arden Jessica D, Gruner Morgan F, Vu Charles C, Marvin Kimberly, Ye Hong, Nandalur Sirisha R, Al-Wahab Zaid, Gadzinski Jill, Rakowski Joseph Anthony, Field Jayson, Rosen Barry, Jawad Maha Saada
Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan.
Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio.
Adv Radiat Oncol. 2020 Sep 9;5(6):1240-1247. doi: 10.1016/j.adro.2020.08.012. eCollection 2020 Nov-Dec.
After definitive surgery, women with early-stage, low-risk endometrial cancer are observed. However, some will require salvage radiation therapy for recurrence. The purpose of this study was to evaluate our experience using salvage radiation for recurrent endometrial cancer in patients who did not receive upfront adjuvant therapy.
Twenty-eight women with endometrial cancer who had undergone initial definitive hysterectomy without adjuvant therapy developed isolated local or regional recurrence and were treated with salvage radiation in our department from 2004 to 2018. Salvage radiation included whole pelvic radiation, vaginal brachytherapy, or both. Patient and tumor characteristics, treatment details, and toxicities were recorded and analyzed.
The median time to first recurrence was 1.7 years. First recurrences consisted of local recurrence in 23 patients, regional recurrence in 4, and both in 1. The median times from hysterectomy to first recurrence, local and regional, were 1.2 and 4.0 years, respectively. All patients underwent salvage radiation for management of their first recurrence. The median total equivalent dose in 2 Gy fractions for this treatment was 67.6 Gy (37.5-81.8 Gy). Two second recurrences occurred following salvage treatment, both local recurrence, at 6.5 and 13.5 months after radiation. The 2-year rates of local control, disease-free survival, and overall survival were 93%, 80%, and 88%, respectively. Treatment was well-tolerated, with low rates of gastrointestinal and genitourinary toxicity.
In this group of patients, salvage radiation therapy for local or regional recurrence of endometrial cancer resulted in excellent control with low rates of acute and chronic toxicities.
早期低风险子宫内膜癌女性患者在接受根治性手术后需进行观察。然而，部分患者复发时需要接受挽救性放疗。本研究旨在评估我们对未接受 upfront 辅助治疗的复发性子宫内膜癌患者进行挽救性放疗的经验。
2004 年至 2018 年期间，28 例接受了初始根治性子宫切除术且未接受辅助治疗的子宫内膜癌女性患者出现孤立性局部或区域复发，并在我院接受了挽救性放疗。挽救性放疗包括全盆腔放疗、阴道近距离放疗或两者联合。记录并分析患者和肿瘤特征、治疗细节及毒性反应。
首次复发的中位时间为 1.7 年。首次复发包括 23 例局部复发、4 例区域复发和 1 例两者皆有。从子宫切除到首次局部和区域复发的中位时间分别为 1.2 年和 4.0 年。所有患者均接受了挽救性放疗以处理首次复发。该治疗的中位总等效剂量（以 2Gy 分割）为 67.6Gy（37.5 - 81.8Gy）。挽救性治疗后发生了 2 次二次复发，均为局部复发，分别在放疗后 6.5 个月和 13.5 个月。局部控制率、无病生存率和总生存率的 2 年率分别为 93%、80%和 88%。治疗耐受性良好，胃肠道和泌尿生殖系统毒性发生率低。
在这组患者中，子宫内膜癌局部或区域复发的挽救性放疗能实现良好控制，急慢性毒性发生率低。
文中“upfront”未找到完全对应的准确中文释义，这里暂译为“ upfront” ，可根据具体语境灵活调整。
