Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.
Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.
Int J Radiat Oncol Biol Phys. 2021 Aug 1;110(5):1423-1431. doi: 10.1016/j.ijrobp.2021.02.055. Epub 2021 Mar 5.
Our purpose was to evaluate the effect of sequence and type of adjuvant therapy for patients with stage IIIC endometrial carcinoma (EC) on outcomes.
In a multi-institutional retrospective cohort study, patients with stage IIIC EC who had surgical staging and received both adjuvant chemotherapy and radiation therapy (RT) were included. Adjuvant treatment regimens were classified as adjuvant chemotherapy followed by sequential RT (upfront chemo), which was predominant sequence; RT with concurrent chemotherapy followed by chemotherapy (concurrent); systemic chemotherapy before and after RT (sandwich); adjuvant RT followed by chemotherapy (upfront RT); or chemotherapy concurrent with vaginal cuff brachytherapy alone (chemo-brachy). Overall survival (OS) and recurrence-free survival (RFS) rates were estimated by the Kaplan-Meier method.
A total of 686 eligible patients were included with a median follow-up of 45.3 months. The estimated 5-year OS and RFS rates were 74% and 66%, respectively. The sequence and type of adjuvant therapy were not correlated with OS or RFS (adjusted P = .68 and .84, respectively). On multivariate analysis, black race, nonendometrioid histology, grade 3 tumor, stage IIIC2, and presence of adnexal and cervical involvement were associated with worse OS and RFS (all P < .05). Regardless of the sequence of treatment, the most common site of first recurrence was distant metastasis (20.1%). Vaginal only, pelvic only, and paraortic lymph node (PALN) recurrences occurred in 11 (1.6%),15 (2.2 %), and 43 (6.3 %) patients, respectively. Brachytherapy alone was associated with a higher rate of PALN recurrence (15%) compared with external beam radiation therapy (5%) P < .0001.
The sequence and type of combined adjuvant therapy did not affect OS or RFS rates. Brachytherapy alone was associated with a higher rate of PALN recurrence, emphasizing the role of nodal radiation for stage IIIC EC. The vast proportion of recurrences were distant despite systemic chemotherapy, highlighting the need for novel regimens.
我们的目的是评估 IIIC 期子宫内膜癌（EC）患者辅助治疗的顺序和类型对结局的影响。
在一项多机构回顾性队列研究中，纳入了接受手术分期并接受辅助化疗和放疗（RT）的 IIIC 期 EC 患者。辅助治疗方案分为辅助化疗后序贯 RT（先化疗），这是主要的治疗顺序；RT 联合化疗后化疗（同期）；RT 前和后化疗（夹心）；辅助 RT 后化疗（先 RT）；或化疗联合阴道残端近距离放疗（化疗+近距离放疗）。通过 Kaplan-Meier 方法估计总生存率（OS）和无复发生存率（RFS）。
共纳入 686 例符合条件的患者，中位随访时间为 45.3 个月。估计 5 年 OS 和 RFS 率分别为 74%和 66%。辅助治疗的顺序和类型与 OS 或 RFS 无关（调整后的 P 值分别为.68 和.84）。多因素分析显示，黑人种族、非子宫内膜样组织学、肿瘤 3 级、IIIC2 期以及附件和宫颈受累与 OS 和 RFS 较差相关（均 P <.05）。无论治疗顺序如何，首次复发最常见的部位是远处转移（20.1%）。仅阴道、仅盆腔和腹主动脉旁淋巴结（PALN）复发分别为 11 例（1.6%）、15 例（2.2%）和 43 例（6.3%）。单独使用近距离放疗与 PALN 复发率较高（15%）相关，而与外照射放疗（5%）相比，P <.0001。
联合辅助治疗的顺序和类型并不影响 OS 或 RFS 率。单独使用近距离放疗与 PALN 复发率较高相关，强调了淋巴结放疗在 IIIC 期 EC 中的作用。尽管接受了全身化疗，但绝大多数复发为远处转移，这突出了需要新的治疗方案。
