Schmitt G, Carl U M, Pape H, Vernimmen F J
Klinik für Strahlentherapie und Radiologische Onkologie, Universität Düsseldorf.
Strahlenther Onkol. 1994 Oct;170(10):561-4.
Divergent opinions exist on the value of adjuvant treatment in endometrial cancer. This paper aims at clarifying the indications for adjuvant radiotherapy by reviewing the literature and presenting own data.
For endometrial cancer 5-year survival data are analysed with respect to the value of adjuvant radiotherapy and/or chemo-/hormone therapy.
Adjuvant radiotherapy in FIGO stage I and II tumors reduces pelvic recurrence rates from 15 to 20% to 1 to 5%. In high risk stage I patients the 5-year survival rate is increased by 30 to 40% using pre-operative high dose endocavitary brachytherapy or postoperative external beam therapy. In stage II disease the 5-year survival rate is increased to 60 to 80% when applying 50 to 60 Gy post surgery. In stage III and IV tumors primary radiotherapy results in 5-year survival rates of 16 to 40%.
In stage I and II endometrial cancer primary treatment consists of surgery followed by radiotherapy in eligible cases. In stage III and IV tumors primary radiotherapy is generally advocated. No properly randomized trials are available to date on the value of adjuvant treatment. There is a great demand for such trials in order to confirm the available data. According to the extent of the disease and the discrimination of certain risk groups these trials should include external beam pelvic irradiation, brachytherapy, para-aortic irradiation as well as systemic chemo-or hormone therapy.
对于子宫内膜癌辅助治疗的价值存在不同观点。本文旨在通过回顾文献并展示自身数据来阐明辅助放疗的适应证。
分析子宫内膜癌5年生存数据，以探讨辅助放疗和/或化疗/激素治疗的价值。
对于国际妇产科联盟（FIGO）Ⅰ期和Ⅱ期肿瘤，辅助放疗可将盆腔复发率从15%至20%降低至1%至5%。对于高危Ⅰ期患者，术前高剂量腔内近距离放疗或术后外照射可使5年生存率提高30%至40%。在Ⅱ期疾病中，术后应用50至60 Gy放疗可使5年生存率提高至60%至80%。对于Ⅲ期和Ⅳ期肿瘤，原发灶放疗可使5年生存率达到16%至40%。
在Ⅰ期和Ⅱ期子宫内膜癌中，主要治疗方法是手术，符合条件的病例术后进行放疗。对于Ⅲ期和Ⅳ期肿瘤，一般提倡原发灶放疗。目前尚无关于辅助治疗价值的恰当随机试验。迫切需要进行此类试验以证实现有数据。根据疾病范围和特定风险组的区分，这些试验应包括盆腔外照射、近距离放疗、腹主动脉旁照射以及全身化疗或激素治疗。
