Ackerman I, Malone S, Thomas G, Franssen E, Balogh J, Dembo A
Department of Radiation Oncology, University of Toronto, Toronto-Sunnybrook Regional Cancer Centre, North York, Canada.
Gynecol Oncol. 1996 Feb;60(2):177-83. doi: 10.1006/gyno.1996.0022.
Fifty-four patients with recurrent endometrial carcinoma were identified from a retrospective review of charts of 304 endometrial cancer patients seen between 1983 and 1989 at our center. A review was undertaken to identify the patterns of relapse, to determine the outcome of salvage treatment, to examine the factors predictive of effective salvage, and, if salvage is effective, to assess an alternative strategy to routine adjuvant postoperative pelvic radiotherapy. Forty percent of the entire recurrent population are long-term survivors. Of the 54 relapsing patients, primary therapy had been surgery alone in 32 and surgery and adjuvant radiotherapy (rt) in 22. Isolated pelvic recurrence was the predominate relapse site in those who had not received adjuvant pelvic RT as primary therapy (23 of 32 or 72%). Distant relapse predominated in those who received adjuvant RT (17 or 22 or 77%). Twenty-eight (54%) failed in the pelvis alone, and 26 (46%) had a component of distant failure. Of the 28 with isolated pelvic relapse, 16 had vaginal mucosal disease involvement only and 12 had disease in the parametrium and/or the pelvic sidewall. With a minimum follow-up for the survivors of 5 years, 21 of the 28 with isolated pelvic relapse received radical radiotherapy and 14 or 67% had maintained pelvic control until death or last follow-up. Eleven of 14 (79%) with disease confined to the mucosa had pelvic control, whereas only 3 of 7 (43%) with extramucosal disease were controlled. No patient experienced major treatment-related toxicity. Tumor size, anatomic extent of pelvic recurrence, RT dose, and disease-free interval were examined for prognostic significance for pelvic control and survival by univariate analysis. Only anatomic extent of pelvic recurrence showed a nonstatistically significant trend as a predictor for control with P = 0.08. In conclusion, a significant proportion of patients with disease recurrence confined to the pelvis can be rendered disease-free long-term with maintained pelvic control. A reexamination of the role of routine adjuvant pelvic RT is therefore undertaken in light of these data.
通过对1983年至1989年间在我们中心就诊的304例子宫内膜癌患者病历进行回顾性研究，确定了54例复发性子宫内膜癌患者。进行了一项研究，以确定复发模式，确定挽救治疗的结果，检查预测有效挽救的因素，并且，如果挽救有效，评估一种替代常规辅助术后盆腔放疗的策略。整个复发人群中有40%是长期存活者。在这54例复发患者中，32例的初始治疗仅为手术，22例的初始治疗为手术加辅助放疗（RT）。在那些未接受辅助盆腔RT作为初始治疗的患者中，孤立性盆腔复发是主要的复发部位（32例中的23例，即72%）。接受辅助RT的患者中远处复发占主导（22例中的17例，即77%）。28例（54%）仅在盆腔复发，26例（46%）有远处复发成分。在28例孤立性盆腔复发患者中，16例仅累及阴道黏膜，12例累及子宫旁组织和/或盆腔侧壁。对存活者进行至少5年的随访，28例孤立性盆腔复发患者中有21例接受了根治性放疗，14例（67%）直至死亡或最后一次随访时仍保持盆腔控制。14例中11例（79%）病变局限于黏膜者实现了盆腔控制，而7例中仅3例（43%）黏膜外病变者实现了盆腔控制。没有患者经历严重的治疗相关毒性。通过单因素分析检查肿瘤大小、盆腔复发的解剖范围、放疗剂量和无病间期对盆腔控制和生存的预后意义。只有盆腔复发的解剖范围显示出作为控制预测指标的非统计学显著趋势，P = 0.08。总之，相当一部分疾病复发局限于盆腔的患者可以长期无病生存并保持盆腔控制。因此，根据这些数据对常规辅助盆腔放疗的作用进行了重新审视。
