放化疗序贯治疗局部晚期子宫内膜癌患者
Sequencing chemotherapy before radiotherapy for women with stage IIIC endometrial cancer.
机构信息
Gynecologic Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA.
Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota, USA.
出版信息
Int J Gynecol Cancer. 2021 May;31(5):702-708. doi: 10.1136/ijgc-2020-002158. Epub 2021 Mar 26.
OBJECTIVE
It is unclear how to best sequence adjuvant chemotherapy and radiotherapy for advanced endometrial cancer. We studied the outcomes for women treated with chemotherapy before radiotherapy in a chemotherapy-first (chemotherapy for 6 cycles followed radiotherapy) or 'sandwich' approach (chemotherapy for 3 cycles followed by radiotherapy and subsequently chemotherapy for 3 cycles).
METHODS
Women with stage IIIC endometrial cancer and no gross residual disease treated with chemotherapy before radiotherapy between April 2003 and April 2016 were included. The Kaplan-Meier method was used to estimate recurrence and survival. We performed a meta-analysis of endometrial cancer trials comparing chemotherapy and radiotherapy versus radiotherapy alone.
RESULTS
A total of 102 patients were included. The mean (SD) age was 63.8 (10.6) years; 84 patients received the chemotherapy-first approach and 18 patients received the 'sandwich' approach. Pelvic and para-aortic nodes were removed in 99% and 88.2%, respectively. Among all the patients, we observed 1 pelvic (1%), 1 para-aortic (1%), and 5 vaginal (4.9%) recurrences. At 3 years, for the 'sandwich' and chemotherapy-first approaches, the vaginal recurrence was 11.8% and 4.2%, pelvic recurrence was 0% and 1.5%, para-aortic recurrence was 0% and 1.2%, distant recurrence was 42.9% and 24.4%, and overall survival was 70.3% and 81.7%, respectively. With 'chemotherapy before radiotherapy' 94.9% completed 4+ chemotherapy cycles (vs 71-90% reported in the literature for 'radiotherapy before chemotherapy'). In a meta-analysis of endometrial cancer trials, distant recurrence rates were reduced with 4+ chemotherapy cycles but not with 3 cycles (p=0.01).
CONCLUSION
Chemotherapy before radiation sequencing for stage IIIC endometrial cancer was associated with a high proportion of patients completing 4+ chemotherapy cycles and low locoregional lymphatic recurrence rate, despite delaying radiotherapy until after 3-6 cycles of chemotherapy and not administering concurrent cisplatin.
目的
对于晚期子宫内膜癌，如何最佳地序贯辅助化疗和放疗尚不清楚。我们研究了采用化疗优先（化疗 6 个周期后行放疗）或“夹心”（化疗 3 个周期后行放疗，随后化疗 3 个周期）方法治疗的患者的结局。
方法
纳入 2003 年 4 月至 2016 年 4 月期间接受化疗优先治疗（化疗前放疗）且无大体残留疾病的 IIIC 期子宫内膜癌患者。采用 Kaplan-Meier 法估计复发和生存情况。我们对比较化疗联合放疗与单纯放疗的子宫内膜癌试验进行了荟萃分析。
结果
共纳入 102 例患者。患者的平均（SD）年龄为 63.8（10.6）岁；84 例患者接受化疗优先方案，18 例患者接受“夹心”方案。盆腔和腹主动脉淋巴结清扫率分别为 99%和 88.2%。所有患者中，我们观察到 1 例盆腔（1%）、1 例腹主动脉（1%）和 5 例阴道（4.9%）复发。3 年时，“夹心”和化疗优先方案的阴道复发率分别为 11.8%和 4.2%，盆腔复发率分别为 0%和 1.5%，腹主动脉复发率分别为 0%和 1.2%，远处复发率分别为 42.9%和 24.4%，总生存率分别为 70.3%和 81.7%。采用“化疗优先”方案，94.9%的患者完成了 4 个周期以上的化疗（而文献报道的“放疗优先”方案的完成率为 71-90%）。在子宫内膜癌试验的荟萃分析中，4 个周期以上的化疗可降低远处复发率，但 3 个周期的化疗则不然（p=0.01）。
结论
对于 IIIC 期子宫内膜癌，化疗优先序贯放疗的方法与较高比例的患者完成 4 个周期以上化疗和较低的局部区域淋巴复发率相关，尽管将放疗推迟至化疗 3-6 个周期后进行，且未给予顺铂同步治疗。
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