早期子宫体非子宫内膜样癌的辅助性阴道介入放疗：一项系统综述
Adjuvant vaginal interventional radiotherapy in early-stage non-endometrioid carcinoma of corpus uteri: a systematic review.
作者信息
De Felice Francesca, Lancellotta Valentina, Vicenzi Lisa, Costantini Sara, Antonacci Alfredo, Cerboneschi Valentina, di Cristino Daniela, Tagliaferri Luca, Cerrotta Annamaria, Vavassori Andrea, Gribaudo Sergio, Colombo Alessandro, Lucà Francesco, Barbara Raffaele, Mangoni Monica, Marampon Francesco, Musio Daniela, Bellati Filippo, Ruscito Ilary, Torcia Francesco, Tombolini Vincenzo, Osti Mattia Falchetto, De Sanctis Vitaliana
机构信息
Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia - Gemelli ART (Advanced Radiation Therapy), Interventional Oncology Center (IOC), Roma, Italy.
出版信息
J Contemp Brachytherapy. 2021 Apr;13(2):231-243. doi: 10.5114/jcb.2021.105292. Epub 2021 Apr 14.
PURPOSE
This systematic review focused on rare histological types of corpus uteri malignancy, including uterine carcinosarcoma (UCS), uterine clear cell carcinoma (UCCC), and uterine papillary serous carcinoma (UPSC), and it is proposed to assist with clinical decision-making. Adjuvant treatment decisions must be made based on available evidences. We mainly investigated the role of vaginal interventional radiotherapy (VIRt) in UCS, UCCC, and UPSC managements.
MATERIAL AND METHODS
A systematic research using PubMed and Cochrane library was conducted to identify full articles evaluating the efficacy of VIRt in early-stage UPSC, UCCC, and UCS. A search in ClinicalTrials.gov was performed in order to detect ongoing or recently completed trials as well as in PROSPERO for ongoing or recently completed systematic reviews. Survival outcomes and toxicity rates were obtained.
RESULTS
All studies were retrospective. For UCS, the number of evaluated patients was 432. The 2- to 5-year average local control (LC) was 91% (range, 74.2-96%), disease-free survival (DFS) 88% (range, 82-94%), overall survival (OS) 79% (range, 53.8-84.3%), the average 5-year cancer-specific survival (CSS) was 70% (range, 70-94%), and G3-G4 toxicity was 0%. For UCCC, the number of investigated patients was 335 (UCCC - 124, mixed - 211), with an average 5-year LC of 100%, DFS of 83% (range, 82-90%), OS of 93% (range, 83-100%), and G3-G4 toxicity of 0%. For UPSC, the number of examined patients was 1,092 (UPSC - 866, mixed - 226). The average 5-year LC was 97% (range, 87.1-100%), DFS 84% (range, 74.7-95.6%), OS 93% (range, 71.9-100%), CSS 89% (range, 78.9-94%), and G3-G4 toxicity was 0%.
CONCLUSIONS
These data suggest that in adequately selected early-stage UPSC and UCCC patients, VIRt alone may be suitable in women who underwent surgical staging and received adjuvant chemotherapy. In early-stage UCS, a multidisciplinary therapeutic approach has to be planned, considering high-rate of pelvic and distant relapses.
目的
本系统评价聚焦于子宫恶性肿瘤的罕见组织学类型，包括子宫癌肉瘤（UCS）、子宫透明细胞癌（UCCC）和子宫浆液性乳头状癌（UPSC），旨在为临床决策提供帮助。辅助治疗决策必须基于现有证据做出。我们主要研究了阴道介入放疗（VIRt）在UCS、UCCC和UPSC治疗中的作用。
材料与方法
利用PubMed和Cochrane图书馆进行系统研究，以确定评估VIRt在早期UPSC、UCCC和UCS中疗效的全文文章。在ClinicalTrials.gov上进行检索，以查找正在进行或最近完成的试验，并在PROSPERO上查找正在进行或最近完成的系统评价。获取生存结果和毒性率。
结果
所有研究均为回顾性研究。对于UCS，评估患者数量为432例。2至5年的平均局部控制率（LC）为91%（范围74.2 - 96%），无病生存率（DFS）为88%（范围82 - 94%），总生存率（OS）为79%（范围53.8 - 84.3%），平均5年癌症特异性生存率（CSS）为70%（范围70 - 94%），3 - 4级毒性为0%。对于UCCC，研究患者数量为335例（UCCC - 124例，混合型 - 211例），平均5年LC为100%，DFS为83%（范围82 - 90%），OS为93%（范围83 - 100%），3 - 4级毒性为0%。对于UPSC，检查患者数量为1092例（UPSC - 866例，混合型 - 226例）。平均5年LC为97%（范围87.1 - 100%），DFS为84%（范围74.7 - 95.6%），OS为93%（范围71.9 - 100%），CSS为89%（范围78.9 - 94%），3 - 4级毒性为0%。
结论
这些数据表明，在经过适当选择的早期UPSC和UCCC患者中，单独使用VIRt可能适用于接受手术分期并接受辅助化疗的女性。在早期UCS中，鉴于盆腔和远处复发率较高，必须制定多学科治疗方案。
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