Gong Xinyue, Sun Shuai, Yan Junfang, Wang Wenhui, Ren Kang, Hou Xiaorong, Hu Ke, Zhang Fuquan
Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences &Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China.
Eight-Year Program of Clinical Medicine, Peking Union Medical College, Chinese Academy of Medical Science &Peking Union Medical College, Beijing, 100730, People's Republic of China.
BMC Womens Health. 2024 Oct 1;24(1):542. doi: 10.1186/s12905-024-03361-z.
This study evaluates the efficacy and toxicity of image-guided brachytherapy combined with or without external beam radiotherapy (IGBT ± EBRT) as definitive treatment for patients with inoperable endometrial cancer (IOEC), in addition to establishing a risk classification to predict prognosis.
Fifty-one IOEC patients who underwent IGBT ± EBRT at Peking Union Medical College Hospital from January 2012 to December 2021 were retrospectively analyzed, of which 42 patients (82.4%) were treated with IGBT + EBRT and 9 patients (17.6%) with IGBT alone. Establishing risk classification based on FIGO 2009 staging and biopsy pathology, stage III/IV, non-endometrioid, or Grade 3 endometrioid cancer were included in the high-risk group (n = 25), and stage I/II with Grade 1-2 endometrioid cancer was included in the low-risk group (n = 26).
The median follow-up time was 58.0 months (IQR, 37.0-69.0). Clinical complete remission (CR) was achieved in 92.2% of patients after radiotherapy (n = 47). The cumulative incidences of locoregional and distant failure were 19.6% (n = 10) and 7.8% (n = 4), respectively. A total of 20 patients died (39.2%), including 10 cancer-related deaths (19.6%) and 10 comorbidity-related deaths (19.6%). The 5-year locoregional control (LRC), time to progression (TTP), overall survival (OS), and cancer-specific survival (CSS) were 76.9%, 71.2%, 59.4%, and 77.0%, respectively. No Grade 3 or above acute or late toxicities were reported. In univariate analysis, LRC, TTP, and CSS were significantly higher in the low-risk group than in the high-risk group (P < 0.05). After adjusting for age, number of comorbidities, radiotherapy modality, and chemotherapy, the low-risk group was still significantly better than the high-risk group in terms of LRC (HR = 6.10, 95% CI: 1.18-31.45, P = 0.031), TTP (HR = 8.07, 95% CI: 1.64-39.68, P = 0.010) and CSS (HR = 6.29, 95% CI: 1.19-33.10, P = 0.030).
IGBT ± EBRT is safe and effective as definitive treatment for IOEC patients, achieving satisfactory locoregional control, favorable survival outcomes, and low toxicity. Risk classification based on FIGO 2009 staging and biopsy pathology is an independent prognostic factor for LRC, TTP, and CSS.
本研究评估图像引导近距离放射治疗联合或不联合外照射放疗（IGBT±EBRT）作为不可手术切除的子宫内膜癌（IOEC）患者的确定性治疗的疗效和毒性，此外还建立一种风险分类以预测预后。
回顾性分析2012年1月至2021年12月在北京协和医院接受IGBT±EBRT的51例IOEC患者，其中42例（82.4%）接受IGBT+EBRT治疗，9例（17.6%）仅接受IGBT治疗。根据国际妇产科联盟（FIGO）2009分期和活检病理建立风险分类，III/IV期、非子宫内膜样癌或3级子宫内膜样癌纳入高危组（n=25），I/II期1-2级子宫内膜样癌纳入低危组（n=26）。
中位随访时间为58.0个月（四分位间距，37.0-69.0）。放疗后92.2%的患者（n=47）实现临床完全缓解（CR）。局部区域和远处失败的累积发生率分别为19.6%（n=10）和7.8%（n=4）。共有20例患者死亡（39.2%），包括10例癌症相关死亡（19.6%）和10例合并症相关死亡（19.6%）。5年局部区域控制（LRC）、无进展生存期（TTP）、总生存期（OS）和癌症特异性生存期（CSS）分别为76.9%、71.2%、59.4%和77.0%。未报告3级或以上的急性或晚期毒性反应。单因素分析中，低危组的LRC、TTP和CSS显著高于高危组（P<0.05）。在调整年龄、合并症数量、放疗方式和化疗后，低危组在LRC（风险比[HR]=6.10，95%置信区间[CI]：1.18-31.45，P=0.031）、TTP（HR=8.07，95%CI：1.64-39.68，P=0.010）和CSS（HR=6.29，95%CI：1.19-33.10，P=0.030）方面仍显著优于高危组。
IGBT±EBRT作为IOEC患者的确定性治疗是安全有效的，可实现令人满意的局部区域控制、良好的生存结局和低毒性。基于FIGO 2009分期和活检病理的风险分类是LRC、TTP和CSS的独立预后因素。
