Fishman D A, Roberts K B, Chambers J T, Kohorn E I, Schwartz P E, Chambers S K
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Yale University School of Medicine, New Haven, Connecticut 06520-8063, USA.
Gynecol Oncol. 1996 May;61(2):189-96. doi: 10.1006/gyno.1996.0123.
From 1975 to 1992, 54 patients with clinical Stage I and II endometrioid carcinoma of the endometrium, representing 3.5% of all such patients, were deemed medically inoperable and exclusively received radiation therapy. A cohort of 108 operable patients adjusted for age, clinical stage, and grade served as a control group. The 5-year actuarial cancer-specific survivals for patients with Stage I inoperable, Stage 11 inoperable, Stage I operable, and Stage II operable disease were 80, 85, 98, and 100%. The corresponding 5-year overall survival rates were 30, 24, 88, and 85%. Inoperable patients had a median disease-free interval of 36 months for clinical Stage I and 50 months for Stage II disease versus 74.5 and 77 months for the operable patients (P = 0.001). Inoperable patients with Stage I disease had a median survival of 37 months versus 50 months for Stage II (P = NS), with only 7 (13%) of these patients dying with endometrial cancer. Operable patients had a median survival of 75 and 79 months in Stage I and II, respectively, with 14 patients dying with endometrial carcinoma (13%). Stage I and II inoperable patients had significantly shorter survival than operable patients (P < 0.0001). More deaths from intercurrent disease occurred within the inoperable Stage I group than with the operable group (28 of 32 vs 3 of 15, P < 0.0001). Inoperable patients had a significantly shorter overall survival and more deaths due to intercurrent disease than operable patients (P < 0.0001). However, inoperable patients who did not die from intercurrent disease had a median 5-year survival which approaches that of operable patients. Our study demonstrates that exclusive radiation therapy is a well-tolerated and effective treatment for medically inoperable patients.
1975年至1992年期间，54例子宫内膜样腺癌临床I期和II期患者（占所有此类患者的3.5%）被判定为医学上无法手术，仅接受放射治疗。一组108例可手术患者根据年龄、临床分期和分级进行调整，作为对照组。I期无法手术、II期无法手术、I期可手术和II期可手术疾病患者的5年精算癌症特异性生存率分别为80%、85%、98%和100%。相应的5年总生存率分别为30%、24%、88%和85%。无法手术的患者临床I期无病间隔中位数为36个月，II期为50个月，而可手术患者分别为74.5个月和77个月（P = 0.001）。I期疾病无法手术的患者中位生存期为37个月，II期为50个月（P = 无显著性差异），这些患者中只有7例（13%）死于子宫内膜癌。可手术患者I期和II期的中位生存期分别为75个月和79个月，14例患者死于子宫内膜癌（13%）。I期和II期无法手术的患者生存期明显短于可手术患者（P < 0.0001）。无法手术的I期组因并发疾病死亡的人数多于可手术组（32例中的28例对15例中的3例，P < 0.0001）。无法手术的患者总生存期明显短于可手术患者，且因并发疾病死亡的人数更多（P < 0.0001）。然而，未死于并发疾病的无法手术患者的5年中位生存期接近可手术患者。我们的研究表明，单纯放射治疗对于医学上无法手术的患者是一种耐受性良好且有效的治疗方法。
