Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Gynecology Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Gynecol Oncol. 2022 Mar;164(3):550-557. doi: 10.1016/j.ygyno.2021.12.022. Epub 2021 Dec 30.
Radiation therapy (RT) may improve outcomes for patients with oligometastatic cancer. We sought to determine if there are long-term survivors treated with definitive RT for recurrent or oligometastatic gynecological cancer (ROMGC), and to evaluate the clinical and disease characteristics of these patients.
We performed a landmark analysis in 48 patients with ROMGC who survived for ≥5 years following definitive RT of their metastasis. Patient characteristics were extracted from the medical record. DFS was modeled using the Kaplan-Meier method.
This cohort included 20 patients (42%) with ovarian cancer, 16 (33%) with endometrial cancer, 11 (23%) with cervical cancer, and one (2%) with vaginal cancer. The sites of ROMGC were the pelvic (46%), para-aortic (44%), supraclavicular (7%), mediastinal (4%), axillary (4%) lymph nodes and the lung (5.5%). Median total RT dose and fractionation were 62.1 Gy and 2.1 Gy/fraction; one patient was treated with SBRT. 32 patients (67%) received chemoradiation; these patients had higher rates of median DFS than those treated with RT alone (93 vs. 34 months, P = 0.05). At median follow-up of 11.7 years, 11 (23%) patients had progression of disease. 20 (42%) patients had died, 9 (19%) died from non-gynecologic cancer and 8 (17%) from gynecologic cancer (three were unknown). 25 (52%) patients were alive and disease-free (10 initially had endometrial cancer [63% of these patients], eight had cervical cancer [73%], six had ovarian cancer [30%], one had vaginal cancer [100%]).
Long-term survival is possible for patients treated with definitive RT for ROMG, however randomized data are needed to identify which patients derive the most benefit.
放射治疗（RT）可能改善寡转移癌症患者的预后。我们旨在确定是否有接受根治性 RT 治疗复发性或寡转移性妇科癌症（ROMGC）的长期生存者，并评估这些患者的临床和疾病特征。
我们对 48 例接受根治性 RT 治疗其转移灶后生存时间≥5 年的 ROMGC 患者进行了里程碑式分析。从病历中提取患者特征。使用 Kaplan-Meier 法对 DFS 进行建模。
该队列包括 20 例（42%）卵巢癌、16 例（33%）子宫内膜癌、11 例（23%）宫颈癌和 1 例（2%）阴道癌患者。ROMGC 的部位为盆腔（46%）、腹主动脉旁（44%）、锁骨上（7%）、纵隔（4%）、腋窝（4%）淋巴结和肺（5.5%）。中位总 RT 剂量和分割剂量分别为 62.1Gy 和 2.1Gy/次；1 例患者接受 SBRT 治疗。32 例（67%）患者接受放化疗；这些患者的中位 DFS 率高于仅接受 RT 治疗的患者（93 与 34 个月，P=0.05）。中位随访时间为 11.7 年，11 例（23%）患者疾病进展。20 例（42%）患者死亡，9 例（19%）死于非妇科癌症，8 例（17%）死于妇科癌症（3 例原因未知）。25 例（52%）患者存活且无疾病（10 例最初患有子宫内膜癌[这些患者中有 63%]，8 例患有宫颈癌[73%]，6 例患有卵巢癌[30%]，1 例患有阴道癌[100%]）。
接受根治性 RT 治疗 ROMG 的患者有长期生存的可能，但需要随机数据来确定哪些患者获益最大。
