Division of Radiation Oncology, London Health Sciences Center, Western University, London, ON N6A 5W9, Canada.
Radiation Oncology Service, Centre Intégré de Cancérologie (CIC), Hôpital de l'Enfant-Jésus, Centre Hospitalier Universitaire de Québec, Québec, QC G1J 1Z4, Canada.
Curr Oncol. 2024 Jun 29;31(7):3758-3770. doi: 10.3390/curroncol31070277.
Serous endometrial carcinoma (SEC) is a high-risk subtype of endometrial cancer. The effectiveness of multiple adjuvant therapies, namely chemotherapy (CT), radiotherapy (RT), and sequential/concurrent chemotherapy with radiotherapy (CRT), have previously been investigated. However, optimal management of early-stage SEC remains unclarified. All cases of early-stage SEC (FIGO 2009 stages I-II) treated in our institution from 2002 to 2019 were identified. Patient data were documented until September 2023. Overall survival (OS) and disease-free survival (DFS) were computed using Kaplan-Meier estimates and Cox's proportional hazard model; descriptive statistical analysis was performed. A total of 50 patients underwent total hysterectomy-bilateral salpingo-oophorectomy and omentectomy, displaying stage IA (60%), IB (24%), and II (16%) disease. The median follow-up was 90.9 months. Patients underwent adjuvant CRT ( = 36, 72%), CT ( = 6, 12%), or RT ( = 6, 12%). Two patients were observed and excluded from analyses. The 42 patients who received radiotherapy had pelvic external beam radiotherapy ( = 10), vaginal brachytherapy ( = 21), or both ( = 11). CRT had better OS (HR 0.14, 95%CI 0.04-0.52, < 0.005) and DFS (HR 0.25, 95%CI 0.07-0.97, = 0.05) than CT alone. RT displayed no OS or DFS benefits compared to CT/CRT. Recurrences were mostly distant. Acute and late G3-4 toxicities were primarily hematologic. Our data underline the challenge of treating SEC. CRT appears to be superior to CT alone but not to RT. Most recurrences were distant, highlighting the need for optimized systemic treatment options.
浆液性子宫内膜癌（SEC）是一种子宫内膜癌的高危亚型。先前已经研究了多种辅助治疗方法的有效性，即化疗（CT）、放疗（RT）以及放化疗序贯/同时治疗（CRT）。然而，早期 SEC 的最佳治疗方法仍不明确。
我们机构在 2002 年至 2019 年间对所有接受治疗的早期 SEC（FIGO 2009 分期 I-II 期）患者进行了识别。患者数据记录截至 2023 年 9 月。采用 Kaplan-Meier 估计和 Cox 比例风险模型计算总生存率（OS）和无病生存率（DFS）；进行描述性统计分析。
共有 50 例患者接受了全子宫切除术-双侧输卵管卵巢切除术和网膜切除术，显示 IA 期（60%）、IB 期（24%）和 II 期（16%）疾病。中位随访时间为 90.9 个月。患者接受辅助 CRT（n=36，72%）、CT（n=6，12%）或 RT（n=6，12%）。两名患者被观察并排除在分析之外。接受放疗的 42 例患者接受了盆腔外照射放疗（n=10）、阴道近距离放疗（n=21）或两者联合治疗（n=11）。与单独 CT 相比，CRT 具有更好的 OS（HR 0.14，95%CI 0.04-0.52，<0.005）和 DFS（HR 0.25，95%CI 0.07-0.97，=0.05）。与 CT/CRT 相比，RT 对 OS 或 DFS 没有获益。复发主要为远处转移。急性和晚期 G3-4 毒性主要为血液学毒性。
我们的数据强调了治疗 SEC 的挑战。CRT 似乎优于单独 CT，但不如 RT。大多数复发为远处转移，这突出了需要优化系统治疗选择的必要性。
