Hicks M L, Piver M S, Puretz J L, Hempling R E, Baker T R, Mcauley M, Walsh D L
Department of Gynecologic Oncology, Roswell Park Cancer Institute, Buffalo, NY 14263.
Int J Radiat Oncol Biol Phys. 1993 Jul 15;26(4):607-11. doi: 10.1016/0360-3016(93)90276-2.
The purpose of this study was (a) to evaluate the incidence of paraaortic lymph node metastasis from adenocarcinoma of the endometrium clinically limited to the uterus (1971 FIGO Stages I and II) and (b) to report the 5 year disease-free survival of patients with histologically documented paraaortic lymph node metastasis from endometrial adenocarcinoma clinically limited to the uterus treated on two separate protocols.
From June 1979 to June 1990, 109 patients underwent staging paraaortic lymphadenectomy or paraaortic lymph node biopsy at the time of total abdominal hysterectomy and bilateral salpingo-oophorectomy for adenocarcinoma of the endometrium clinically limited to the uterus. Patients with histologically documented paraaortic lymph node metastasis were treated on two protocols: (a) pelvic radiation (5,040 cGy) plus progestins or (b) pelvic radiation therapy (5,040 cGy) plus paraaortic radiation (4,500 cGy).
Paraaortic lymph node metastases was primarily associated with grade 3 tumors (34.4%) and deep myometrial invasion (42%) and was present in 17.4% (19) of 109 patients. None of the women treated with pelvic radiation therapy and progestins survived five years disease-free. In contrast, the 5 year disease-free survival was 27% for patients treated by pelvic and paraaortic radiation.
Since all patients with macroscopic metastases to the paraaortic lymph nodes developed recurrent cancer and only a small percentage of those with microscopic metastases to the paraaortic lymph nodes survived disease-free at 5 years, improved survival for patients with paraaortic lymph node metastases will necessitate the addition of effective cytotoxic chemotherapy to pelvic and paraaortic radiation.
本研究的目的是（a）评估临床局限于子宫的子宫内膜腺癌（1971年国际妇产科联盟分期I期和II期）腹主动脉旁淋巴结转移的发生率，以及（b）报告根据两种不同方案治疗的临床局限于子宫的子宫内膜腺癌且组织学证实有腹主动脉旁淋巴结转移患者的5年无病生存率。
1979年6月至1990年6月，109例临床局限于子宫的子宫内膜腺癌患者在全腹子宫切除及双侧输卵管卵巢切除时接受了分期性腹主动脉旁淋巴结清扫术或腹主动脉旁淋巴结活检。组织学证实有腹主动脉旁淋巴结转移的患者按两种方案治疗：（a）盆腔放疗（5040 cGy）加孕激素，或（b）盆腔放疗（5040 cGy）加腹主动脉旁放疗（4500 cGy）。
腹主动脉旁淋巴结转移主要与3级肿瘤（34.4%）和子宫肌层深层浸润（42%）相关，109例患者中有17.4%（19例）存在该转移。接受盆腔放疗加孕激素治疗的女性无一人存活5年无病。相比之下，接受盆腔和腹主动脉旁放疗的患者5年无病生存率为27%。
由于所有腹主动脉旁淋巴结有肉眼可见转移的患者均发生了复发性癌症，而仅有一小部分腹主动脉旁淋巴结有显微镜下转移的患者5年无病存活，因此，要提高腹主动脉旁淋巴结转移患者的生存率，有必要在盆腔和腹主动脉旁放疗基础上加用有效的细胞毒性化疗。
