Kupelian P A, Eifel P J, Tornos C, Burke T W, Delclos L, Oswald M J
Division of Radiotherapy, University of Texas M. D. Anderson Cancer Center, Houston 77030.
Int J Radiat Oncol Biol Phys. 1993 Nov 15;27(4):817-24. doi: 10.1016/0360-3016(93)90454-4.
To review the results of treatment with radiotherapy alone in 152 patients with adenocarcinoma of the endometrium who had medical or surgical contraindications to hysterectomy.
We reviewed the records of all patients who were treated with radiotherapy alone for uterine carcinoma at The University of Texas M. D. Anderson Cancer Center between 1960 and 1986. One hundred fifty-two cases were analyzed. Most patients had multiple medical problems. One hundred sixteen patients were treated with intracavitary radiotherapy alone. A combination of external beam and intracavitary radiotherapy was used for 10 patients with Stage I disease who had unusually large cavities, 10 patients with Stage II disease, and 13 of 15 patients with Stage III or IV disease. Histologic material was reviewed in 91 cases.
Ten years after treatment, these patients were twice as likely to have died of intercurrent illness as of uterine cancer. The 5-year disease-specific survival rate of patients with Stage I disease was 87%. The disease-specific survival of patients with Stage II disease was 88%, which was not significantly different from that of Stage I patients. Stage III and IV patients had a significantly poorer disease-specific survival rate of 49% at 5 years. Intrauterine recurrence occurred in 14% of the patients with Stage I or II disease. Salvage treatment was attempted in 5 of the 10 patients who had isolated intrauterine recurrences of Stage I disease and was successful in all cases. Extrauterine pelvic recurrence developed in only 3% of Stage I and II patients. Of 82 Stage I and II carcinomas that were available for pathologic review, 17 (21%) were clear-cell or papillary serous variants. The disease-specific survival rate of patients with Stage I or II papillary serous carcinomas was 43%, significantly poorer than that of patients with endometrioid carcinomas. Seven patients experienced acute anesthesia-related complications; none were fatal. Five patients had serious late complications of radiation therapy.
Radical radiotherapy achieved acceptable DSS and local control rates in patients with medically or surgically inoperable uterine carcinoma. However for patients with localized disease, such treatment is justified only when the operative risk exceeds the 10-15% uterine recurrence rate expected with radiation alone.
回顾152例因医学或手术原因不宜行子宫切除术的子宫内膜腺癌患者单纯放疗的治疗结果。
我们回顾了1960年至1986年间在德克萨斯大学MD安德森癌症中心接受单纯子宫癌放疗的所有患者的记录。分析了152例病例。大多数患者有多种内科问题。116例患者仅接受腔内放疗。10例I期子宫腔异常大的患者、10例II期患者以及15例III期或IV期患者中的13例采用了体外照射与腔内放疗联合的方式。91例病例的组织学资料进行了复查。
治疗后10年，这些患者死于并发疾病的可能性是死于子宫癌的两倍。I期患者的5年疾病特异性生存率为87%。II期患者的疾病特异性生存率为88%，与I期患者无显著差异。III期和IV期患者5年的疾病特异性生存率显著较差，为49%。I期或II期疾病患者中有14%发生子宫内复发。10例I期疾病孤立性子宫内复发的患者中有5例尝试了挽救性治疗，所有病例均成功。I期和II期患者中仅3%发生子宫外盆腔复发。在82例可供病理复查的I期和II期癌中，17例（21%）为透明细胞或乳头状浆液性变体。I期或II期乳头状浆液性癌患者的疾病特异性生存率为43%，显著低于子宫内膜样癌患者。7例患者出现急性麻醉相关并发症；均非致命。5例患者有严重的放疗晚期并发症。
根治性放疗在因医学或手术原因无法手术的子宫癌患者中取得了可接受的疾病特异性生存率和局部控制率。然而，对于局限性疾病患者，只有当手术风险超过单纯放疗预期的10 - 15%的子宫复发率时，这种治疗才是合理的。
