Wang Wenhui, Sun Shuai, Miao Zheng, Hou Xiaorong, Zhang Fuquan, Hu Ke
Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Oncol. 2021 Jan 22;10:608152. doi: 10.3389/fonc.2020.608152. eCollection 2020.
Low-grade endometrial stromal sarcoma (LG-ESS) is a rare gynecological tumor. Whether adjuvant radiotherapy benefits survival in patients with resected early-stage ESS remains controversial. This study was designed to explore the role of adjuvant radiotherapy in stage I to II LG-ESS.
We retrospectively reviewed patients with stage I to II LG-ESS in our center from Jan. 1998 to Feb. 2018. All patients underwent a total hysterectomy and postoperative radiotherapy was administrated based on clinical and pathological characteristics.
A total of 152 patients with stage I to II resected LG-ESS were included. Forty patients received adjuvant radiotherapy (RT group) while 112 patients did not receive adjuvant radiotherapy (no RT group). The baseline characteristics of the two groups were comparable, except that the proportion of stage II patients in the RT group was higher than that in the no RT group (32.5% vs. 11.6%, in RT vs. no RT groups, respectively; p = 0.003). For both patient groups, median overall survival was not reached. The median disease-free survival (DFS) was 144 months. Radiotherapy was associated with significantly improved DFS (92 months vs. not reached in RT vs. no RT groups, respectively; p = 0.008) and pelvic failure-free survival (PFFS) (92 months vs. not reached in RT vs. no RT groups, respectively; p=0.004). Subgroup analysis revealed that RT benefited survival most among patients with stage IB to IIB disease. Adjuvant radiotherapy significantly reduced the pelvic recurrence rate (10.0%, 4/40 vs. 28.6%, 32/112, p = 0.018). No radiotherapy-induced grade 4 to 5 toxicity was observed.
For patients with stage I to II LG-ESS, adjuvant radiotherapy showed significant improvement in DFS and PFFS with tolerable adverse effects, especially in patients with stage IB to IIB disease.
低级别子宫内膜间质肉瘤（LG-ESS）是一种罕见的妇科肿瘤。早期ESS患者接受手术切除后辅助放疗是否能改善生存仍存在争议。本研究旨在探讨辅助放疗在Ⅰ至Ⅱ期LG-ESS中的作用。
我们回顾性分析了1998年1月至2018年2月期间在本中心接受治疗的Ⅰ至Ⅱ期LG-ESS患者。所有患者均接受了全子宫切除术，并根据临床和病理特征给予术后放疗。
共纳入152例接受手术切除的Ⅰ至Ⅱ期LG-ESS患者。40例患者接受了辅助放疗（放疗组），112例患者未接受辅助放疗（未放疗组）。两组的基线特征具有可比性，但放疗组Ⅱ期患者的比例高于未放疗组（分别为32.5%和11.6%，放疗组与未放疗组；p = 0.003）。对于两组患者，总生存期中位数均未达到。无病生存期中位数为144个月。放疗与显著改善的无病生存期（分别为92个月和未达到，放疗组与未放疗组；p = 0.008）和无盆腔失败生存期（PFFS）（分别为92个月和未达到，放疗组与未放疗组；p = 0.004）相关。亚组分析显示，放疗对IB至IIB期疾病患者的生存获益最大。辅助放疗显著降低了盆腔复发率（10.0%，4/40 vs. 28.6%，32/112，p = 0.018）。未观察到放疗引起的4至5级毒性反应。
对于Ⅰ至Ⅱ期LG-ESS患者，辅助放疗在无病生存期和无盆腔失败生存期方面有显著改善，且不良反应可耐受，尤其是对于IB至IIB期疾病患者。
