Sibarani Candra Novi Ricardo, Salima Siti, Adrianto Nicholas
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Padjadjaran University, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.
School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Pluit Raya No.2, Penjaringan, North Jakarta, Jakarta, Daerah Khusus Ibukota, 14440, Indonesia.
J Egypt Natl Canc Inst. 2025 Jun 3;37(1):45. doi: 10.1186/s43046-025-00302-1.
This review assesses the efficacy and safety of EBRT + VBT versus VBT alone in intermediate- to high-risk endometrial cancer.
A systematic review and meta-analysis were conducted using PubMed, EMBASE, ProQuest, Ovid, and Scopus (until February 18, 2025). Studies comparing EBRT + VBT to VBT alone were included. The primary outcome was pelvic recurrence rate, while secondary outcomes included distant recurrence, overall survival, and toxicity. Data extraction, risk of bias assessment (RoB-2, ROBINS-I), and meta-analysis (random-effects models in RevMan) were performed. Certainty of evidence was evaluated using GRADE. PROSPERO registration: CRD420250654411.
Eight studies comprising 2,672 patients met inclusion criteria (1,347 received EBRT + VBT; 1,325 had VBT alone). EBRT + VBT significantly reduced pelvic recurrence (OR 0.14, p = 0.001) but showed no difference in vaginal recurrence (OR 0.25, p = 0.14), distant metastasis (OR 0.78, p = 0.45) or overall survival (HR 0.82, p = 0.29, I = 72%). EBRT + VBT was associated with higher gastrointestinal, genitourinary, and hematologic toxicity.
EBRT + VBT improves pelvic control but does not enhance survival and increases toxicity. VBT alone remains a viable option, highlighting the need for individualized treatment strategies.
本综述评估了外照射放疗（EBRT）联合阴道近距离放疗（VBT）与单纯VBT治疗中高危子宫内膜癌的疗效和安全性。
使用PubMed、EMBASE、ProQuest、Ovid和Scopus（截至2025年2月18日）进行系统评价和荟萃分析。纳入比较EBRT联合VBT与单纯VBT的研究。主要结局是盆腔复发率，次要结局包括远处复发、总生存期和毒性。进行了数据提取、偏倚风险评估（RoB-2、ROBINS-I）和荟萃分析（RevMan中的随机效应模型）。使用GRADE评估证据的确定性。PROSPERO注册号：CRD420250654411。
八项研究共2672例患者符合纳入标准（1347例接受EBRT联合VBT；1325例仅接受VBT）。EBRT联合VBT显著降低了盆腔复发（比值比[OR]0.14，p = 0.001），但在阴道复发（OR 0.25，p = 0.14）、远处转移（OR 0.78，p = 0.45）或总生存期（风险比[HR]0.82，p = 0.29，I² = 72%）方面无差异。EBRT联合VBT与更高的胃肠道、泌尿生殖系统和血液学毒性相关。
EBRT联合VBT改善了盆腔控制，但未提高生存率且增加了毒性。单纯VBT仍是一个可行的选择，凸显了个体化治疗策略的必要性。
