Ørtoft Gitte, Fokdal Lars Ulrick, Høgdall Claus
Department of Gynaecology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Department of Oncology, University Hospital of South Denmark, Vejle, Denmark.
Int J Gynecol Cancer. 2025 Aug;35(8):101861. doi: 10.1136/ijgc-2024-005772. Epub 2025 Apr 19.
In Denmark, adjuvant radiotherapy has gradually been omitted after surgery in endometrial cancer. This study analyses the impact of this strategy on patterns of recurrence and outcome after salvage radiotherapy. Moreover, the potential effect of adjuvant radiotherapy is estimated in the non-low-risk cohort.
The cohort included 3723 consecutive Danish patients with endometrial cancer who had radical surgery without adjuvant treatment (2005-2012). The patients were divided into low-risk (stage 1A, endometrioid, grades 1, 2 and no lymph-vascular space invasion) and non-low-risk. Crude/actuarial recurrence rates evaluated the number of patients who might have benefited from additional adjuvant radiotherapy.
Within 9 years' observation time using crude recurrence rates, 13.4% recurred.The rate of isolated vaginal recurrences was 2.9% in low-risk compared with 6.7% in non-low-risk patients. Isolated pelvic recurrences were 0.8% in low-risk compared with 2.1% in non-low-risk patients. In all, 15.8% of non-low-risk patients died from endometrial cancer, mainly due to primary or secondary non-local recurrences (a later non-local recurrence after a primary isolated local recurrence). Only 0.6% and 1.1% of all non-low-risk patients died from an isolated vaginal or pelvic recurrence, respectively. In all, 86% of all patients with an isolated vaginal recurrence were treated with curative intent. Of these, 72% were given radiotherapy with a local control rate of 91% (crude rate). However, even though only 5.8% died of an unsuccessfully treated isolated vaginal recurrence after curative intended radiotherapy, 23.1% died from a secondary non-local recurrence, while 22.3% died from other causes.
The Danish strategy of omitting adjuvant radiotherapy is safe. Adjuvant external beam radiotherapy may have prevented isolated local recurrences in 8.7% of the Danish non-low-risk patients, but a majority of these patients were salvaged by curative radiotherapy with 91% and 70% crude local control rates for isolated vaginal and isolated pelvic recurrences, respectively.
在丹麦，子宫内膜癌术后逐渐不再进行辅助放疗。本研究分析了这一策略对挽救性放疗后复发模式和结局的影响。此外，还评估了辅助放疗在非低危队列中的潜在效果。
该队列包括3723例连续的丹麦子宫内膜癌患者，这些患者接受了根治性手术且未接受辅助治疗（2005 - 2012年）。患者被分为低危组（1A期，子宫内膜样癌，1级、2级且无淋巴血管间隙浸润）和非低危组。粗/精算复发率用于评估可能从额外辅助放疗中获益的患者数量。
在9年的观察期内，使用粗复发率，13.4%的患者复发。低危组孤立性阴道复发率为2.9%，非低危组为6.7%。低危组孤立性盆腔复发率为0.8%，非低危组为2.1%。总体而言，15.8%的非低危患者死于子宫内膜癌，主要是由于原发性或继发性非局部复发（原发性孤立局部复发后出现的后期非局部复发）。所有非低危患者中分别仅有0.6%和1.1%死于孤立性阴道或盆腔复发。总体而言，所有孤立性阴道复发患者中有86%接受了根治性治疗。其中，72%接受了放疗，局部控制率为91%（粗率）。然而，尽管在根治性放疗后仅有5.8%的患者死于未成功治疗的孤立性阴道复发，但23.1%的患者死于继发性非局部复发，22.3%的患者死于其他原因。
丹麦省略辅助放疗的策略是安全的。辅助外照射放疗可能使8.7%的丹麦非低危患者避免了孤立性局部复发，但这些患者中的大多数通过根治性放疗得到挽救，孤立性阴道和孤立性盆腔复发的粗局部控制率分别为91%和70%。
