Ahmad N R, Lanciano R M, Corn B W, Schultheiss T
Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
Int J Radiat Oncol Biol Phys. 1995 Nov 1;33(4):837-42. doi: 10.1016/0360-3016(95)00197-0.
To evaluate the impact of prolonged overall radiation treatment (RT) time and surgery-to-radiation interval on local control (LC) and disease-specific survival (DSS) of surgically staged endometrial cancer patients in relation to known prognostic factors.
Between 1971 and 1993, 195 endometrial cancer patients received postoperative RT at the Fox Chase Cancer Center. All patients underwent total abdominal hysterectomy (TAH), with 38% also having lymph node sampling. All patients received whole pelvic external beam RT to a median dose of 45 Gy (range 40 to 60 Gy). Sixty-nine percent received a vaginal cuff boost with either low dose rate or high dose rate brachytherapy. Tumor and treatment factors were analyzed for impact on LC and DSS. Median follow-up was 47 months (range: 6 to 187 months).
The overall actuarial 5-year LC rate was 85%. In multivariate analysis, tumor grade, pathologic stage, external radiation dose, and surgical lymph node evaluation were independent prognostic variables for improved LC. Surgery-to-radiation interval of greater than 6 weeks was a marginally significant factor for decreased LC (p = 0.06). Overall RT time and external beam treatment time did not appear to impact LC rates. The overall actuarial 5-year DSS rate was 86%. In multivariate analysis, depth of myometrial invasion, tumor grade, and pathologic stage were independent prognostic variables for DSS. In addition, a surgery-to-radiation interval of greater than 6 weeks was significantly associated with decreased DSS (p < 0.005).
Surgery-to-radiation interval of greater than 6 weeks is a significant independent prognostic variable for decreased DSS and a marginally significant variable for decreased LC in patients irradiated postoperatively for endometrial cancer. Other time factors (overall RT time and external beam treatment time) did not appear to impact outcome. Based on this analysis, postoperative radiation therapy for endometrial cancer should be initiated within 6 weeks following surgery.
评估延长总体放疗（RT）时间和手术至放疗间隔时间对手术分期子宫内膜癌患者局部控制（LC）和疾病特异性生存（DSS）的影响，并与已知预后因素相关联。
1971年至1993年间，195例子宫内膜癌患者在福克斯蔡斯癌症中心接受了术后放疗。所有患者均接受了全腹子宫切除术（TAH），38%的患者还进行了淋巴结取样。所有患者均接受全盆腔外照射放疗，中位剂量为45 Gy（范围40至60 Gy）。69%的患者接受了低剂量率或高剂量率近距离放疗的阴道残端补量。分析肿瘤和治疗因素对LC和DSS的影响。中位随访时间为47个月（范围：6至187个月）。
总体精算5年LC率为85%。在多变量分析中，肿瘤分级、病理分期、外照射剂量和手术淋巴结评估是改善LC的独立预后变量。手术至放疗间隔时间大于6周是LC降低的一个边缘显著因素（p = 0.06）。总体RT时间和外照射治疗时间似乎并未影响LC率。总体精算5年DSS率为86%。在多变量分析中，肌层浸润深度、肿瘤分级和病理分期是DSS的独立预后变量。此外，手术至放疗间隔时间大于6周与DSS降低显著相关（p < 0.005）。
对于接受子宫内膜癌术后放疗的患者，手术至放疗间隔时间大于6周是DSS降低的一个显著独立预后变量，也是LC降低的一个边缘显著变量。其他时间因素（总体RT时间和外照射治疗时间）似乎并未影响预后。基于该分析，子宫内膜癌术后放疗应在手术后6周内开始。
