Department of Radiation Oncology, Faculty of Medicine, Adana Dr. Turgut Noyan Research and Treatment Center, Baskent University, Adana, Turkey.
Department of Radiation Oncology, Faculty of Medicine, Başkent University, Ankara, Turkey.
Acta Oncol. 2021 Sep;60(9):1154-1160. doi: 10.1080/0284186X.2021.1926537. Epub 2021 May 17.
We sought to analyze the toxicity rates and the treatment outcomes in endometrial cancer (EC) patients treated with postoperative three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT).
The clinical data of 646 EC patients treated with postoperative adjuvant 3DCRT (265 patients, 41%) or with IMRT (381 patients, 59%) between April 2007 and August 2019 were retrospectively analyzed. The primary endpoints were treatment-related acute and late gastrointestinal (GI) and genitourinary (GU) toxicities. The secondary endpoints were LC and overall survival (OS) and disease-free survival (DFS).
Median follow-up time was 37 months. The rates for acute GI and GU toxicities of any grade for the entire group were 55.6% and 46.8%, respectively. Acute grade ≥2 GI toxicity was significantly less in patients treated with IMRT compared to those treated with 3DCRT (11.0% vs. 19.2%, =.004). However, no significant difference grade ≥2 GU toxicities was observed between the 3DCRT and IMRT groups (15.1% vs. 11.0%; =.15). Acute grade ≥2 GI and GU toxicities were higher in patients receiving systemic chemotherapy, while paraaortic field irradiation increases only the risk of acute grade ≥2 GI toxicity. Estimated 3-year late grade ≥3 GI toxicity rates in the 3DCRT- and IMRT-treated patients were 4.6% and 1.9% (= .03), respectively. The patients treated with adjuvant ChT had higher rates of late serious GI complications than those without adjuvant ChT. No significant difference in terms of survival and disease control was observed between the 3DCRT and IMRT treatment groups. No significant factor for LC was found in the multivariate analysis.
In this multicentric study involving one of largest patient population, we found that IMRT-treated EC patients showed comparable clinical outcomes but with a lower incidence of GI toxicities compared with those treated with 3DCRT.
我们旨在分析接受术后三维适形放疗（3DCRT）和调强放疗（IMRT）治疗的子宫内膜癌（EC）患者的毒性发生率和治疗结局。
回顾性分析 2007 年 4 月至 2019 年 8 月期间接受术后辅助 3DCRT（265 例，41%）或 IMRT（381 例，59%）治疗的 646 例 EC 患者的临床资料。主要终点为治疗相关的急性和迟发性胃肠道（GI）和泌尿生殖系统（GU）毒性。次要终点为无病生存期（DFS）和总生存期（OS）及局部控制率（LC）。
中位随访时间为 37 个月。全组患者急性 GI 和 GU 毒性的任何等级发生率分别为 55.6%和 46.8%。与 3DCRT 组相比，IMRT 组治疗的患者急性 GI 毒性≥2 级的发生率显著降低（11.0%比 19.2%，=.004）。然而，3DCRT 和 IMRT 组之间未观察到 GU 毒性≥2 级的差异（15.1%比 11.0%；=.15）。接受全身化疗的患者急性 GI 和 GU 毒性≥2 级的发生率较高，而腹主动脉旁野照射仅增加急性 GI 毒性≥2 级的风险。3DCRT 和 IMRT 治疗患者的 3 年估计晚期 GI 毒性发生率分别为 4.6%和 1.9%（=.03）。接受辅助化疗的患者发生晚期严重 GI 并发症的比率高于未接受辅助化疗的患者。3DCRT 和 IMRT 治疗组在生存和疾病控制方面无显著差异。多因素分析未发现 LC 的显著因素。
在这项涉及最大患者群体之一的多中心研究中，我们发现与 3DCRT 治疗相比，接受 IMRT 治疗的 EC 患者具有相似的临床结局，但 GI 毒性发生率较低。
