Rovirosa Ángeles, Zhang Yaowen, Tanderup Kari, Ascaso Carlos, Chargari Cyrus, Van der Steen-Banasik Elzbieta, Wojcieszek Piotr, Stankiewicz Magdalena, Najjari-Jamal Dina, Hoskin Peter, Han Kathy, Segedin Barbara, Potter Richard, Van Limbergen Erik
Fonaments Clinics Dpt., Faculty of Medicine, Universitat de Barcelona, 08036 Barcelona, Spain.
Radiation Oncology Dpt., Hospital Clinic-Universitat de Barcelona, 08036 Barcelona, Spain.
Cancers (Basel). 2023 Sep 27;15(19):4750. doi: 10.3390/cancers15194750.
BACKGROUND/PURPOSE: Analyse the outcomes of stages I-III inoperable endometrial cancer (IEC) patients treated with external-beam-irradiation (EBRT) and 3D-image-guided-brachytherapy (IGBT).
Medical records of IEC patients receiving EBRT + IGBT in eight European and one Canadian centres (2004-2019) were examined, including: pelvic ± para-aortic EBRT and lymph node boost; anaesthetic procedure, applicators, BT-planning imaging, clinical target volume (CTV), brachytherapy schedule, and EQD2 to the CTV and D2 cm for organs at risk. Complications are evaluated using CTCAEv4 scores. The 2- and 5-year survival probability according to stages was estimated (cancer-specific survival (CSS), disease-free survival (DFS), local relapse-free survival (LRFS), loco-regional relapse-free survival (LRRFS), and distant metastasis-free survival (DMFS)).
descriptive analysis and the Kaplan-Meier method.
103 patients (stages: I-44, II-14, III-44) were included. Median follow-up: 28 months (7-170). All patients received pelvic ± para-aortic EBRT. Median D90-EQD2 to the CTV:73.3 Gy (44.6-132.7), 69.9 Gy (44.7-87.9 and 75.2 Gy (55.1-97) in stages I, II, and III, respectively. Thirty patients presented relapse (stages: 10-I, 3-II, 17-III): 24 uterine (stages: 7-I, 3-II, 14-III), 15 nodal (stages: 4-I, 1-II, 10-III), and 23 distant (stages: 6-I, 2-II, 15-III). Five year CSS was 71.2% (stages: 82%-I-II and 56%-III) and DFS, LRFS, LRRFS, and DMFS were 55.5%, 59%, 72%, and 67.2%, respectively. Late G3-G4 complications (crude): 1.3% small bowel, 2.5% rectum, and 5% bladder.
In stages I-III of the IEC, EBRT + IGBT offer good 2- and 5-year CSS of 88.7% and 71.2%, respectively, with the best outcomes in stages I-II. Prospective studies are needed to determine how better outcomes can be achieved.
背景/目的：分析接受外照射放疗（EBRT）和三维图像引导近距离放疗（IGBT）治疗的Ⅰ-Ⅲ期不可手术子宫内膜癌（IEC）患者的治疗结果。
检查了8个欧洲和1个加拿大中心（2004 - 2019年）接受EBRT + IGBT治疗的IEC患者的病历，包括：盆腔±腹主动脉旁EBRT及淋巴结增敏；麻醉程序、施源器、近距离放疗计划成像、临床靶区（CTV）、近距离放疗方案以及CTV和危及器官D2 cm处的等效均匀剂量（EQD2）。使用CTCAEv4评分评估并发症。根据分期估计2年和5年生存概率（癌症特异性生存（CSS）、无病生存（DFS）、局部无复发生存（LRFS）、区域无复发生存（LRRFS）和远处转移无复发生存（DMFS））。
描述性分析和Kaplan - Meier方法。
纳入103例患者（分期：Ⅰ期44例，Ⅱ期14例，Ⅲ期44例）。中位随访时间：28个月（7 - 170个月）。所有患者均接受盆腔±腹主动脉旁EBRT。CTV的中位D90 - EQD2：Ⅰ期为73.3 Gy（44.6 - 132.7），Ⅱ期为69.9 Gy（44.7 - 87.9），Ⅲ期为75.2 Gy（55.1 - 97）。30例患者出现复发（分期：Ⅰ期10例，Ⅱ期3例，Ⅲ期17例）：24例为子宫复发（分期：Ⅰ期7例，Ⅱ期3例，Ⅲ期14例），15例为淋巴结复发（分期：Ⅰ期4例，Ⅱ期1例，Ⅲ期10例），23例为远处复发（分期：Ⅰ期6例，Ⅱ期2例，Ⅲ期15例）。5年CSS为71.2%（分期：Ⅰ - Ⅱ期为82%，Ⅲ期为56%），DFS、LRFS、LRRFS和DMFS分别为55.5%、59%、72%和67.2%。晚期3 - 4级并发症（粗发生率）：小肠为1.3%，直肠为2.5%，膀胱为5%。
在IEC的Ⅰ - Ⅲ期，EBRT + IGBT分别提供了良好的2年和5年CSS，分别为88.7%和71.2%，在Ⅰ - Ⅱ期效果最佳。需要进行前瞻性研究以确定如何取得更好的治疗效果。
