Grigsby P W, Kuske R R, Perez C A, Walz B J, Camel M H, Kao M S, Galakatos A
Int J Radiat Oncol Biol Phys. 1987 Apr;13(4):483-8. doi: 10.1016/0360-3016(87)90061-7.
Definitive therapy for Stage I adenocarcinoma of the endometrium consists of total abdominal hysterectomy and bilateral salpingo-oophorectomy. Pre- and/or post-operative radiotherapy (RT) is employed in selected patients with poor prognostic factors such as poorly differentiated tumors or deep myometrial invasion by tumor. The results are reported of RT alone in 69 patients with Stage I adenocarcinoma of the endometrium who presented with severe, acute, and chronic medical illnesses which prevented surgical management of their disease. Sixty-three patients (91.3%) were obese or hypertensive. Twenty-seven patients (39.1%) had diabetes mellitus, 16 (23.2%) had congestive heart failure, and the remaining patients had such conditions as stroke (17.4%), coronary artery disease (15.9%), and recent myocardial infarction (13.0%). The median age for this group of patients was 72.0 years compared to 60.0 years for a concurrent group of 304 patients with Stage I adenocarcinoma of the endometrium treated at our institution with combined surgery and RT. RT consisted of intracavitary insertions alone (11 patients), intracavitary plus low dose external beam therapy (9 patients), and intracavitary therapy plus high dose external beam therapy (49 patients, definitive RT). Younger patients and those with poorly differentiated disease were treated more aggressively. The 5- and 10-year overall survival for all patients was 76.8 and 33.3%, respectively. The 5- and 10-year disease-free survival was 88.1 and 82.4%, respectively. The 5-year overall and disease-free survival for the group of 49 patients treated with definitive RT was 85.4% and 88.7% with 15/49 (30.6%) having poorly differentiated tumors. For the definitive therapy group, the 5- and 10-year disease-free survival was 94.3, 92.3, and 78.0% for grades I, II, and III, respectively. Analysis of patterns of failure showed that none of the patients failed in the pelvis alone. Two out of 11 (18.2%) receiving intracavitary therapy alone and 3/49 (6.1%) receiving definitive RT failed in the pelvis with simultaneous distant metastasis (DM). Three patients in the definitive RT group failed with DM only. Severe complications occurred in 8 patients (16%), all of whom received definitive RT.
子宫内膜I期腺癌的确定性治疗包括全腹子宫切除术和双侧输卵管卵巢切除术。对于具有预后不良因素的特定患者，如肿瘤分化差或肿瘤侵犯子宫肌层较深，可采用术前和/或术后放疗（RT）。报告了69例子宫内膜I期腺癌患者单纯放疗的结果，这些患者患有严重的急慢性内科疾病，无法进行手术治疗。63例患者（91.3%）肥胖或患有高血压。27例患者（39.1%）患有糖尿病，16例（23.2%）患有充血性心力衰竭，其余患者患有中风（17.4%）、冠状动脉疾病（15.9%）和近期心肌梗死（13.0%）等疾病。该组患者的中位年龄为72.0岁，而我院同期接受手术联合放疗的304例子宫内膜I期腺癌患者的中位年龄为60.0岁。放疗包括单纯腔内植入（11例患者）、腔内加低剂量外照射治疗（9例患者）和腔内治疗加高剂量外照射治疗（49例患者，确定性放疗）。年轻患者和疾病分化差的患者接受的治疗更为积极。所有患者的5年和10年总生存率分别为76.8%和33.3%。5年和10年无病生存率分别为88.1%和82.4%。接受确定性放疗的49例患者中，5年总生存率和无病生存率分别为85.4%和88.7%，其中15/49（30.6%）为肿瘤分化差的患者。对于确定性治疗组，I、II和III级患者的5年和10年无病生存率分别为94.3%、92.3%和78.0%。失败模式分析表明，没有患者仅在盆腔出现失败。单纯接受腔内治疗的11例患者中有2例（18.2%）和接受确定性放疗的49例患者中有3例（6.1%）在盆腔出现失败并同时发生远处转移（DM）。确定性放疗组有3例患者仅出现DM失败。8例患者（16%）出现严重并发症，所有这些患者均接受了确定性放疗。
